NRP Quiz

Question 1

You have started positive-pressure ventilation for a newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation?

Answer 1

A rising heart rate

Question 2

What is an indication for endotracheal intubation?

Answer 2

The need for positive pressure ventilation lasting more than a few minutes.

Question 3

MR. SOPA helps your team correct problems with ventilation. What are the steps?

Answer 3

Adjust mask and Reposition head and neck; Suction mouth then nose and Open the mouth; increase Pressure; insert Alternative airway

Question 4

What is the appropriate technique to stimulate a baby to breath?

Answer 4

Gently rub the baby’s back or extremites.

Question 5

The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process?

Answer 5

Initiate positive pressure ventilation and check for increasing heart rate.

Question 6

What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room?

Answer 6

Place a pulse oximeter on the baby’s right hand or wrist and assess oxygen saturation.

Question 7

You are at the resuscitation of a newborn who is gasping and has a heart rate of 60bpm. What is the most important action you can take?

Answer 7

Provide positive-pressure ventilation

Question 8

During the resuscitation of a newborn you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team?

Answer 8

100 beats per minute

Question 9

What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps?

Answer 9

Administration of positive-pressure ventilation that inflates the lungs.

Question 10

What are the initial steps of newborn care?

Answer 10

Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate.

Question 11

What is the recommended practice when using a pulse oximeter in the delivery room?

Answer 11

Place the pulse oximeter sensor on the right hand or wrist and use the minute specific oxygen saturation target to guide oxygen supplementation.

Question 12

What is a normal transitional physiology at the time of birth (as pertains to oxygen saturation)?

Answer 12

Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.

Question 13

What size endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)?

Answer 13

2.5mm

Question 14

You are uncertain whether you have successfully intubated a newborn. What diagnostic can be used to confirm placement?

Answer 14

CO2 detector indicates the presence of expired CO2

Question 15

You attend to a baby post emergency cesarean delivery, who is term as expected, with very poor tone and he is apneic. You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation?

Answer 15

Start positive-pressure ventilation and check heart rate response after 15 seconds

Question 16

A newborn of 34 weeks’ gestation apneic at birth, does not respond to initial steps and requires positive-pressure ventilation. What concentration of oxygen should be used?

Answer 16

FiO2 of 21 - 30%

Question 17

What is a critical characteristic in team leaders?

Answer 17

Maintain situational awareness.

Question 18

You are part of a team preparing for the birth of a baby who has meconium-stained fluid and a category III fetal heart rate tracing. Who should you ensure is present at the birth?

Answer 18

A person skilled in endotracheal intubation

Question 19

The steps of intubation should ideally be completed within which duration?

Answer 19

30 seconds

Question 20

Four pre-birth questions should be asked to assess perinatal risk and determine who should be present at the birth. What are they?

Answer 20

• What is the expected gestational age?
• Is the amniotic fluid clear?
• How many babies are expected?
• Are there any additional risk factors?

Question 21

For every delivery, what is the minimum requirement for care of the newborn at birth?

Answer 21

Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn.

Question 22

A baby is born at 34 weeks’ gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps?

Answer 22

Initiate positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate.

Question 23

At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with his mother or be moved to the radiant warmer for further assessment?

Answer 23

Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying?

Question 24

A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated?

Answer 24

Insert a laryngeal mask

Question 25

You are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help?

Answer 25

Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.

Question 26

How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?

Answer 26

1 minute

Question 27

Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine?

Answer 27

The baby’s heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.

Question 28

Your team begins administering chest compressions to a newborn. Correct technique for compressions?

Answer 28

Thumbs remain in contact with the chest at all times.

Question 29

When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation?

Answer 29

The option of providing comfort care can be considered.

Question 30

What is the preferred method for assessing heart rate during chest compressions?

Answer 30

Electronic cardiac (ECG) monitoring

Question 31

Which ethical principle(s) guide the resuscitation of a newborn?

Answer 31

The approach to decisions in the newborn should be guided by the same principles used for adults and older children.

Question 32

A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?

Answer 32

Respirations, heart rate, oxygen saturation

Question 33

When are chest compressions indicated?

Answer 33

When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.

Question 34

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. What must be included in the baby’s subsequent care?

Answer 34

Monitor blood glucose levels because of the risk of hypoglycemia after birth.

Question 35

For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?

Answer 35

0.1 mL

Question 36

What may be associated with delayed cord clamping in vigorous preterm newborns?

Answer 36

Decreased need for blood transfusions

Question 37

A baby’s heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. What is a common cause of this type of asymmetric breath sounds in an intubated baby?

Answer 37

Endotracheal tube inserted too deep

Question 38

What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg?

Answer 38

1.5mL

Question 39

What time frame should be used to administer intravenous epinephrine?

Answer 39

Rapid push, as quickly as possible

Question 40

In preparation for the initial steps for a known very preterm birth, what should you have ready?

Answer 40

Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.

Question 41

During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen. She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side. What is the most likely cause of this distress?

Answer 41

Left-sided pneumothorax

Question 42

A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?

Answer 42

Stop chest compressions; continue positive-pressure ventilation.

Question 43

A baby born at 36 weeks’ gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. What should be checked soon after resusitation?

Answer 43

His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.

Question 44

After chest compressions with coordinated ventilations are started, when should the heart rate be assessed?

Answer 44

After 60 seconds

Question 45

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

Answer 45

The newborn’s parents

Question 46

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby is 5 minutes old and breathing spontaneously. The baby’s heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby’s respirations are labored. What is the next appropriate action?

Answer 46

Administer CPAP at 5 cm H20 pressure

Question 47

Why is it important to maintain appropriate body temperature in babies that suffered brain injury from decreased oxygen and blood flow to the brain (hypoxic-ischemic encephalopathy)?

Answer 47

A high body temperature (hyperthermia) may worsen neurologic outcomes.

Question 48

What does positive-pressure ventilation increases the risk of?

Answer 48

pneumothorax

Question 49

When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?

Answer 49

30 breaths, 90 compressions

1 and 2 and 3 and breath