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CCRN Neonatal Examination practices 2024
A deformation is a(n) - Correct Answer 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 - Correct Answer conduction. At the onset of labor the release of catecholamines stimulates - Correct Answer 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 - Correct Answer 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 - Correct Answer term, small for gestational age. During fetal life, the ductus arteriosus - Correct Answer 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 - Correct Answer 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 - Correct Answer gonorrhea. Following a birth complicated by shoulder dystocia, the neonate should be assessed for - Correct Answer Erb's palsy.
Preeclampsia may result in all of the following fetal conditions - Correct Answer 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 - Correct Answer environmental. In the immediate newborn transition period, the ability to maintain functional residual lung capacity is most dependent upon - Correct Answer an adequate amount of alveolar surfactant. 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. Polycythemia in the immediate newborn period is often associated with - Correct Answer infant of a diabetic mother. Symptoms of mild perinatal asphyxia include - Correct Answer hyperalert state and jitteriness. 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 following conditions may all lead to metabolic acidosis - Correct Answer loss of HCO3/excess acid load d/t prematurity, renal tubular necrosis, severe diarrhea, hypoxia, hypoperfusion, inborn errors of metabolism, caloric deprivation, intolerance of cow's milk protein. The full newborn cardiovascular assessment includes auscultation, inspection, and palpation. The point of maximum impulse is usually palpable and can be auscultated in the - Correct Answer 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
- Correct Answer congenital malformations.
During which phase of fetal pulmonary development do the type II pneumocytes become numerous and begin to produce and store surfactant? - Correct Answer Canalicular phase An absence of air flow despite respiratory effort is an example of which apnea classification? - Correct Answer Obstructive apnea Continuous positive airway pressure (CPAP) improves oxygenation by - Correct Answer improving the ventilation-perfusion ratio. The functional residual capacity in a newborn infant should be approximately - Correct Answer 30 ml/kg. A 29 week gestation infant who displays symptoms of a pulmonary hemorrhage should be evaluated for - Correct Answer patent ductus arteriosus. The most significant role of surfactant in neonatal lung development is to - Correct Answer maintain alveolar stability by decreasing surface tension. Most respiratory disorders result in a ventilation-perfusion mismatch. Ideally, the ventilation-perfusion ratio should be - Correct Answer 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? - Correct Answer Intraventricular hemorrhage Which of the following conditions is not an air leak? - Correct Answer Pneumatosis intestinalis 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 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.
Neonates receiving surfactant are at increased risk of developing - Correct Answer pulmonary hemorrhage. A discrepancy greater than 10 mm Hg between the blood pressure in the upper and lower extremities is indicative of which defect? - Correct Answer 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? - Correct Answer 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? - Correct Answer Transposition of the great vessels A right-to-left shunt will be seen with - Correct Answer pulmonary stenosis. Appropriate nutritional management of the neonate with congestive heart failure is best achieved by which of the following? - Correct Answer Individualizing to minimize energy consumption At approximately _____ weeks of gestation the heart has developed a fully functioning electrical conduction system. - Correct Answer 10 It is important to evaluate the neonate with critical pulmonary stenosis for - Correct Answer symptoms of right-sided congestive heart failure. One of the medications given to cause constriction and closure of the ductus arteriosus in the neonate is - Correct Answer indomethacin. Parallel circulations in which there are separate pulmonary and systemic circulatory systems occur in - Correct Answer transposition of the great vessels. Pulmonary venous congestion is most commonly identified with which of the following defects? - Correct Answer Hypoplastic left heart
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?
- Correct Answer Preload Which types of shock are commonly seen in the infant who is septic? - Correct Answer Distributive and hypovolemic With a complete endocardial cushion defect, blood will flow - Correct Answer 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? - Correct Answer 97th At how many weeks gestation is suck-swallow-breathe coordination present? - Correct Answer 34 - 36 Compared to full term formulas, preterm formulas contain - Correct Answer more calories and increased protein. Complications of percutaneous central venous lines - Correct Answer catheter migration. 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 Disadvantages associated with continuous gavage feedings include all of the following EXCEPT? - Correct Answer Decreases in the amount of gastric acid in the stomach Gluconeogenesis is the process of converting - Correct Answer non-glucose precursors to glucose. 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.
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. One of the advantages human milk has over formula is that it - Correct Answer contains very long-chain fatty acids. Patient care management for the neonate with hypernatremia often includes - Correct Answer monitoring for hyperglycemia and hypocalcemia. 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 Signs of renal compromise or severe fluid deficit will often include a urine output of less than - Correct Answer 0.5 ml/kg/hour. Symptoms of hyperkalemia include - Correct Answer electrocardiographic changes and dysrhythmias. The purpose of trophic feeds is to - Correct Answer stimulate functional development of the GI tract. What is the best treatment option for severe intractable hyperkalemia? - Correct Answer Peritoneal dialysis 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 Which of the following does NOT cross the placenta from the mother to the fetus? - Correct Answer Insulin
Management of the patient with bladder exstrophy includes - Correct Answer covering the defect with plastic wrap. 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 The compromised neonate has difficulty regulating acid-base homeostasis due to - Correct Answer decreased ability to handle acid load. The glomerular filtration rate doubles by the end of the second week of postnatal life because of - Correct Answer increased glomerular surface area. The neonate has difficulty responding to large fluid loads due to a(n) - Correct Answer decreased tubular sensitivity to aldosterone. The new classification for acute kidney injury (AKI) is based on - Correct Answer urine output and change in serum creatinine level. The renin-angiotensin-aldosterone system is responsible for - Correct Answer regulating sodium, potassium, and regional blood flow. Thyroid hormones are required for maturation of which of these systems? - Correct Answer central nervous system. What is the MOST common type of acute renal failure in the neonatal period? - Correct Answer Prerenal 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
Which of the following explains why a preterm infant is at greater risk for negative sodium balance? - Correct Answer There is an increased proportion of water in the extracellular fluid compartment. Which of the following is a common abnormality associated with a hypospadias? - Correct Answer Chordee Which of the following is a prerenal cause of acute renal failure? - Correct Answer 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? - Correct Answer Fungal infection Urinary tract abnormalities, extrinsic obstruction of the urinary tract, fungal infections A common organism responsible for early onset sepsis is - Correct Answer E. coli. MOST common is GBS A newborn with polycythemia may exhibit which of the following? - Correct Answer Tachypnea, thrombocytopenia, hypoglycemia Anemia due to decreased red blood cell survival should be anticipated in the neonate with a history of - Correct Answer isoimmune-mediated hemolysis. Bilirubin levels rise in an infant with severe gram-negative sepsis for which of the following reasons? - Correct Answer Overproduction and decreased excretion of bilirubin Blood products administered to neonates are irradiated to prevent which of the following conditions? - Correct Answer Graft-versus-host disease leukodepleted to prevent against graft v. host disease; irradiated to protect against CMV Complement works with the immune system to - Correct Answer opsonize bacteria to facilitate phagocytosis. Diagnostic test results that indicate thrombocytopenia include - Correct Answer decreased platelet count.
Which of the following statements is MOST accurate when describing the availability of albumin binding sites to bilirubin? - Correct Answer Availability of bilirubin binding sites may be affected by poor nutrition, medications, or intralipids. Which of the following treatments may be used to decrease the need for exchange transfusion in the newborn with extreme or critical hyperbilirubinemia? - Correct Answer Intravenous immunoglobulin Which statement best supports organizational recommendations for prevention of kernicterus or extreme hyperbilirubinemia? - Correct Answer Provide follow up care based on the risk assessment at the time of discharge. promote and support bf, measure tcb w in 24 hours, measure all bili levels according to age in hours... Which type of phototherapy unit provides higher than with traditional fluorescent bulbs? - Correct Answer LED banks and pads Which white blood cell is MOST effective in the destruction of parasites in neonates with a parasitic infection? - Correct Answer Eosinophil You have initiated phototherapy for a two day old preterm newborn with hyperbilirubinemia. After six hours of phototherapy, the total serum bilirubin level is unchanged. What are your thoughts? - Correct Answer Irradiance level should be checked and skin exposure maximized. Symptoms of Polycthemia - Correct Answer Tachypnea, plethora, prolonged cap refill time Symptoms of Anemia - Correct Answer Pallor tachycardia tachypnea Symptoms of Thrombocytopenia - Correct Answer Petechiae, bleeding from IV site, bruising Function of granulocyte - Correct Answer infection response Function of thrombocyte - Correct Answer hemostasis Function of hemoglobin - Correct Answer oxygen carrying protein
Function of erythrocyte - Correct Answer transports oxygen and carbon dioxide Function of T cell - Correct Answer cellular immunity Function of immunoglobulin - Correct Answer specific antibody-mediated response Risk factors for hyperbilirubinemia - Correct Answer prematurity, exclusive breastfeeding, infection, hemoglobinopathies, isoimmunization, polycythemia, delayed meconium passage, cephalohematoma The MOST common signs of pyloric stenosis include - Correct Answer non-bilious emesis that becomes frequent and projectile. The standard for diagnosing gastroesophageal reflux disorder includes which of the following? - Correct Answer pH probe test The clinical presentation of esophageal atresia and tracheoesophageal fistula includes all of the following EXCEPT - Correct Answer history of oligohydramnios. The etiology of necrotizing enterocolitis includes all of the following EXCEPT - Correct Answer breast milk feedings. Maturation of the gastrointestinal tract is MOST influenced by - Correct Answer initiation of feeding. 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. Duodenal atresia is strongly suggested when the abdominal x-ray shows - Correct Answer double-bubble sign. The purpose of minimal enteral feedings is to - Correct Answer prevent the intestinal mucosa from atrophying. Nursing care for the infant with surgical repair of an abdominal wall defect would include - Correct Answer observing for signs of increased intra-abdominal pressure.
An infant exhibiting apnea, bradycardia, decreased reflexes, hypotonia, and unequal pupillary reaction would be diagnosed with which stage of hypoxic ischemic encephalopathy? - Correct Answer Stage III Autoregulation is a process that - Correct Answer 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 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. Which is the BEST reply? - Correct Answer "By taking a prescription dose of 4.0 milligrams of folic acid before a future pregnancy, you can reduce the risk of NTDs." Clinical presentation of subarachnoid hemorrhage - Correct Answer increasing OFC, shock, vacuum-assisted delivery 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 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 Management of the neonate with an intraventricular hemorrhage includes - Correct Answer preventing wide swings in systemic blood pressure. Periventricular leukomalacia may be caused by all of the following physiologic conditions EXCEPT - Correct Answer treatment with extracorporeal membrane oxygenation. Symptoms of subtle seizures include - Correct Answer rowing, stepping, or pedaling movements. motor automatisms, buccolingual movements; most common and account for 1/2 of all seizures; found in preterm and term infants; rowing, stepping, pedaling movements, eye blinking/fluttering, staring, smacking of lips, drooling, sucking on ET tube
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 bundle of fibers which connects the cerebral hemispheres is the - Correct Answer corpus callosum. 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 goals of neuroprotective cooling in infants with hypoxic ischemic encephalopathy include all of the following EXCEPT - Correct Answer increasing the uptake of glutamate. Goal to inhibit brain cell 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 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 Which of the following are signs of hydrocephalus? - Correct Answer Vomiting, lethargy, irritability Which of the following increases cerebral blood flow? - Correct Answer Decreasing pH and hypoglycemia decreased pH, increased K+, hypoxemia, increased osmolarity, hypoglycemia (below 30) Which of the following is NOT a neural tube defect? - Correct Answer Brachial plexus palsy Which of the following newborns meets the criteria for neuroprotective cooling? - Correct Answer 36 weeks, Apgar score of 3 at 10 minutes, cord arterial blood pH 7.05 35 - 36 wks gestation, >1800g, pH<7 with base defecit of >12-16, apgar score<3 at 5 or 10 minutes, and lack of respiratory effort at 10 min
"acid mantle"; adult pH is 5.7; acid mantel is created by chemical and biologic properties at skin surface. Symptoms of zinc deficiency include - Correct Answer excoriations of skin folds. 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 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) 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 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. What is the primary cause of skin breakdown in infants within a newborn intensive care setting? - Correct Answer Use of adhesives to secure tubing Which of the following is the MOST commonly observed newborn rash? - Correct Answer Erythema toxicum Which of the following protocols is used to treat a dobutamine extravasation? Administer - Correct Answer 5 subcutaneous injections of phentolamine (Regitine) around the periphery of the site within one hour of infiltration. phentolamine s/b used to reverse vasoconstricting effects of dopamine; administer hyaluronudase in 4 - 5 0.2 ml sc injections around ther periphery of the injury; tx most effective when done w/in one hour, but may still be beneficial if done in 12 hours. Which of the following statements about hemangiomas is TRUE? - Correct Answer Some hemangiomas are permanent, and others will resolve. nodules, solid, elevated lesions; arise from deeper layers of the skin > 1 cm; more common in preterm infants, females,
caucasian, multiples; referred to as stork bite; blanches w pressure; darkens when crying; includes port wine stains Which of the following statements does not accurately describe the stratum corneum? The stratum corneum - Correct Answer is the outermost layer of cells that form the dermal layer. All late preterm infants are at risk for hypoglycemia due to which of the following? - Correct Answer Impaired ability to generate glucose from glycogen stores and increased glucose utilization All of the following have had an impact on the rising late preterm birth rate EXCEPT - Correct Answer decreasing maternal age. All of the following increase parental confidence in caring for the late preterm infant EXCEPT - Correct Answer open visitation so others can help with newborn care. If the neonate is symptomatic with a plasma glucose value of less than 40mg/dl (2. mmol/L) and is refusing or NOT tolerating feedings, the nurse should request orders for the following interventions: - Correct Answer an intravenous bolus of 2 ml/kg D10W and an intravenous D10W infusion initiated at 80 ml/kg/day. In contrast to term newborns, bilirubin levels in late preterm newborns typically peak at - Correct Answer 5 - 7 days of life 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. Parents should be taught to assess their infant's _________ temperature. - Correct Answer axillary 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. The components of safe sleep include the following EXCEPT - Correct Answer sharing a sleep surface with parents.
