preptest1 Flashcards
(127 cards)
1
Q
What are the 3 main goals in neonatal resuscitation?
A
Warmth & Stimulation
Oxygenation & Ventilation
Circulation
2
Q
Name the 5 parameters scored with APGAR
A
Muscle tone Respirations Reflex Color HR
3
Q
When are the APGAR scores assessed? What intervals
A
1 min after birth, then 5 min
If still below 7, every 5 min until reaches 7 for 20 min
4
Q
T or F: APGAR is not as reliable in VLBW infants
A
True
5
Q
Muscle tone, respiratory effort & reflexes can be important indicators of what two statuses?
A
Neurological & Cardiovascular
6
Q
T or F: Sodium Bicarb, as similar to adult resuscitation care, is very seldom used in post resuscitation care in neonates:
A
False
7
Q
What is the major item of concern in neonates when experiencing respiratory arrest? A. Heart function B. Warming & drying C. Opening airway D. Sepsis E. All of the above
A
C. Opening Airway
8
Q
What is the major item of concern in adults when experiencing respiratory arrest? A. Heart function B. Hydration C. Opening airway D. Septic shock E. All of the above
A
A. Heart Function
9
Q
What are the order of the ABC’s of resuscitation in adults?
A
C A B
10
Q
What are the order of the ABC’s in neonates?
A
A B C
11
Q
How do you address the A of resuscitation in neonates?
A
Airway: Position & Clear
12
Q
How do you address the B of resuscitation in neonates?
A
Breathing: Stimulate
13
Q
How do you address the C of resuscitation in neonates?
A
Circulation: assess HR, oxygenation: oxygen, PPV, intubation
14
Q
How can you determine if apnea is primary vs secondary?
A
If baby responds to stimulation, then primary apnea, if not then secondary
15
Q
What items should be part of resuscitation care monitoring?
A
BP & Vitals
Chest x-ray
Glucose level
16
Q
Respiratory rates that exceed 60 bpm but normalize over next several hours may indicate
a. RDS
b. not abnormal
c. delayed closing of foramen ovale
d. transient tachypnea of newborn
A
D. transient tachypnea of newborn
17
Q
T or F: all newborns display an irregular breathing pattern.
A
True
18
Q
\_\_\_\_\_\_\_\_\_ in premature neonates is characterized by irregular patterns of intermittent respiratory pauses longer than 5 seconds. A. Primary apnea B. Secondary apnea C. periodic breathing D. Late decelerations
A
C. periodic breathing
19
Q
Apnea is a condition in which breathing ceases for longer than _______.
A
15-20
20
Q
How many vessels are present in umbilical cord?
A
3
21
Q
When resuscitation is needed & HR does not improve & you see no chest rise what steps of corrective actions can you take?
A
(MRSOPA) M= Mask Adjustment; R=Reposition Airway as seal may be problem S= Suction mouth, then nose O= Open mouth slightly P= Pressure increases A= Alternative Airway (ET tube, LMA)
22
Q
What type of PPV may be useful in delivery room during mild to moderate respiratory distress? A. BIPAP B. CPAP C. Only blow-by D. HFNC
A
B. CPAP
23
Q
Indications for assisted ventilation include: I. Apnea II. Gasping after stimulation III HR less than 120 IV Irregular breathing pattern A. I & II B. I, II, & III C. I, III, IV D. All of the above
A
I & II= apnea or gasping after stimulation
HR must be less than 100
24
Q
What devices/or apparatus can be used to deliver positive pressure breaths in neonates with mask ventilation? I Blender II. Self inflating Bag III. T-piece resuscitator IV. Oxyhood A. II & III B. I, II, III C. II, III, IV D. All of the above
A
A. Self inflating bag, flow inflating bag, & T piece resuscitator can all provide PPV with mask
25
T or F: Self Inflating Bags cannot deliver high concentrations of O2
False
26
If a pop off valve is present what is the typical preset limits?
30-35 cmH2o
27
How can you monitor pressure with a self inflating bag?
Attach a manometer
28
```
What must you do to deliver high concentrations of O2 with self inflating bags?
I. Add manometer
II. Remove pop off valve
III. Add O2 source
IV. Add an O2 reservoir
A. I, III, IV
B. II, III, IV
C. III, IV
D. All of the above
E. None of the above, only flow inflating bags or T-piece can deliver high concentrations of Oxygen
```
C. Add O2 source & reservoir
29
What is the correct technique for holding a mask to the face of a newborn?
A. Fingers are placed touching neck & soft tissue to hyperextend the neck
B. Fingers placed on anterior margin of mandible, lifting face into mask, not touching neck or soft tissue under chin
C. Placing finger under the chin gently, & hyperextending neck to clear airway
D. Fingers placed at bottom of mask, & top making no contact with neonatal skin
B. Not touching neck or soft tissue under chin
30
```
What is an appropriate pressure range for pre-term infants?
A. 35-40 cmH2O
B. 25-30 CmH2O
C. 20-25 cmH2O
D. 35-45 cmH2O
```
C. 20-25 cmH2O
31
```
What is an appropriate pressure range for unresponsive, term infant?
A. 20-40 cmH2O
B. 15-20 cmH2O
C. 30-50 cmH2O
D. 30-60 cmH2O
```
A. 20-40 cmH2O
32
______ inflates only with pressure and flow from compressed gas source of air, O2 or both.
Flow inflating bag
33
```
With a flow inflating bag how do you prevent over or underdistention & bag nor bag deflation in resuscitation efforts?
I. Use correct gas flows (8-10 lpm)
II. Add peep valve
III. Monitor for tight seal
IV. Correct adjustment of flow control valve
A. I, II, III
B. I, IV
C. II, III, IV
D. All of the above
```
B. Use correct flow, adust flow control valve
34
Which resuscitator can offer reliable control of PIP & PEEP
T piece resuscitator
35
Which device can deliver free flow O2 the best?
Flow inflating
36
Which device best delivers consistent breath to breath pressures?
T piece
37
When intubation is needed with diaphragmatic hernia what else should you do?
Add nasogastric tube to decompress bowel & allow lungs to inflate
38
What is your dose of blood volume expanders?
10 ml/kg
39
T or F: Blood expanders can be given via umbilical vein
True
40
```
_______ is a scoring system used to assess degree of respiratory distress.
A. APGAR
B. Ballard Score
C. Silverman Score
D. Dubouitz Score
E. FBP Score
```
C. Silverman score
41
```
_______ is a scoring system to assess fetal well being & placental function
A. APGAR
B. Ballard Score
C. Silverman Score
D. Dubouitz Score
E. FBP Score
```
E. Fetal Biophysical profile
42
```
_____ is a scoring system to assess gestational age based on 6 neurological & 6 physical parameters & is most reliable if performed within hours after birth.
A. APGAR
B. Ballard
C. Silverman Score
D. Dubouitz Score
E. FBP Score
```
B. Ballard Score
43
```
________ is a scoring system to assess gestational age based on 11 physical & 12 neurological parameters & most reliable when performed within 1st 5 days of life & can be accurate up to 2 weeks.
A. APGAR
B. Ballard
C. Silverman Score
D. Dubouitz Score
E. FBP Score
```
D. Dubouitz Score
44
```
________ is a scoring system to assess status of newborns immediately following birth.
A. APGAR
B. Ballard
C. Silverman
D. Dubouitz Score
E. FBP Score
```
A. APGAR
45
Name 4 types of heat loss
Convective: Object transfers heat to surrounding air
Conductive Heat: Direct contact with body
Evaporative Heat Loss: Via energy when liquid transfers to gas
Radiation Loss: No medium of heat transfer, done via vacuum or electromagnetic waves
46
The use of Warmed blankets is an example of preventing which type of heat loss?
Conductive due to direct contact
47
Control of room temperature & preventing drafts would be an example of preventing what type of heat loss?
Convective
48
Drying the neonate is a form of preventing what type of heat loss?
Evaporation
49
In neonate CPR compressions & PPV must be coordinated with a ratio of?
3:1
50
How many chest compressions should occur in 1 min?
90 compressions in a minute
51
What are two methods for delivering compressions?
Two finger technique
| Thumb technique
52
How often should HR be assessed when performing neonatal CPR?
every 30 seconds
53
What dose of epinephrine can be administered?
0.1-0.3 ml/kg of 1:10,000 solution repeated every 3-5 minutes during pulseless arrest
54
The use of epinephrine in neonates especially poses what hazard?
intracranial bleeding
55
After ______ minutes of resuscitation if no responses discontinuation may be justified if no sign of life
10 min
56
Which of the following is the initial step in stabilizing an infant?
A. proper positioning under radiant warmer
B. Suctioning of mouth and nose with bulb syringe
C. Determining HR
D. Determining APGAR score
A. radiant warmer
57
What is the proper procedure to implement for an infant known to have experienced meconium aspiration?
A. OB should suction the mouth, nose, and pharynx after delivery of head but before delivery of shoulders.
B. Intubate immediately & aspirate trachea, using meconium aspirator regardless of whether infant is vigorous
C. Treat infant exactly as if meconium not present
D. Intubate & suctin only if infant is not vigorous, follow normal resuscitation procedures
D.
58
```
Which of the following is an appropriate way to stimulate an infant
I. Flicking bottoms of feet
II. Gently shaking shoulders
III. Drying with warm towel
IV. Gently rubbing back
A. I, III, IV
B. I, II, III
C. III, & IV
D. All of the above
```
A. I, III, IV
| Not shaking
59
```
When delivering PPV the recommended breath rate is
A. 20-40 bpm
B. 40-60 bpm
C. 60-80 bpm
D. at least 100 bpm
```
B. 40-60 bpm
60
```
Where can HR be best felt on neonate?
A. Brachial pulse
B. Umbilical cord
C. Pedal artery
D. Cephalic Vein
```
B. umbilical cord
61
T or F: If acrocyanosis if present immediately following birth O2 therapy should be given
F: not always required as there is sluggish peripheral circulation immediately following birth
62
T or F: The use of fluid therapy immediately following resuscitation should be avoided due to potential for edema.
False: use of fluid therapy is appropriate
63
```
Following resuscitation the patient must be monitored especially close for:
A. hypoglycemia
B. Hypocalcemia
C. Hyperglycemia
D. Hypercalcemia
E. both A & B
F. Both A & D
G. Both C & D
H. All of the above
```
A & B
| Hypoglycemia & hypocalcemia
64
What is normal HR in neonates?
120-170
65
What is normal BP after 12 hrs of life?
75/50
66
What is a normal Mean BP after 12 hrs?
60 mmHg
67
Capillary refill on neonate should be less than ____.
3 seconds
68
```
Skin color is an indicator of
I. Perfusion
II. intravascular volume
III. HR
IV. Respiratory Rate
A. I, II, III
B. I & II
C. I only
D. All of the above
```
B. I & II
69
Name 5 signs of respiratory distress
Nasal flaring, expiratory grunting, tachypnea, & retractions
70
T or F: In respiratory distress, nasal flaring a sign of air hunger occurs during inspiration in an effort to draw in more air whereas grunting occurs in expiration as an effort to maintain lung volume by increasing end expiratory pressure
T
71
```
Retractions usually:
I occur at inspiration
II occur at expiration
III. Sign of reduced lung compliance
IV. Sign of obstructive airway process
A. I & II, III
B. I, III, IV
C. II, III, IV
D. III only
E. All of the above
```
B. Retractions indicate reduced compliance or normal compliance with obstructive airway, occur at inspiration
72
When comparing the chest wall of neonate with adult, what differences are observed
I. Chest wall & thoracic cage is less flexible
II. Chest wall & thoracic cage is more flexible
III. Retractions are harder to see in neonates due to increased chest wall compliance
IV. Retractions are easier to observe
V. Abdominal & thoracic muscles move in parallel
VI. Abdominal & thoracic muscles move in opposition to each other at inspiration & expiration
A. I, III, VI
B. I & IV
C. II, III, V
D. I, IV, V
D. In neonates:
| Chest wall is: more flexible, easier to identify retractions, & muscles move in parallel
73
T or F: Paradoxical respirations mean thoracic & abdominal respiratory efforts are synchronous.
False: paradoxical respirations mean disynchrony between thoracic & abdominal efforts; this is also seen as a see saw effect & indicates severe respiratory distress
74
T or F: auscultation of the newborn can prove difficult because sounds easily transmit from one lung region to the other as the chest is small & abdominal sounds may be heard as well
True
75
Bowel sounds heart in the place of absent breath sounds is an indicator of _____.
Diaphragmatic hernia
76
To distinguish stridor vs wheezing in neonate, if you place the stethoscope at neck then
A. If stridor: breath sounds are louder at neck than chest
B. If wheezing, Breath sounds louder at neck
C. If wheezing, breath sounds are lower in chest
A. Stridor: breath sounds normally louder at neck than chest; if wheezing then you will probably hear sound louder at chest area then neck
77
If you hear diminished breath sounds this can be caused by:
A. secretions in large bronchi
B. Turbulent air flow from small airway obstruction
C. Pulmonary edema or pneumonia
D. RDS, atelectasis, or pulmonary interstitial edema
D. RDS, atelectasis, PIE, Shallow respirations can cause diminished breath sounds
78
```
______ breath sounds commonly are heard from bronchoconstriction or secretions.
A. Rhonchi
B. Wheezing
C. Stridor
D. Crackles
```
B. Wheezing
79
This breath sound is most commonly heard at inspiration.
A. Stridor
B. Wheezing
A. Stridor normally heard at inspiration & wheezing in expiration in neonates
80
```
These breath sounds commonly heard with RDS:
I. Wheezing at expiration
II. Crackles
III. Rales
IV. Diminished breath sounds
A. II, & III
B. II, III, IV
C. IV only
D. All are commonly present
```
B. RDS often occurs with diminished breath sounds, crackles or rales which may be associated with pulmonary edema
81
If you have an infant that has severe tachypnea, normal chest x-ray, & normal chest exam what most likely may be the cause?
A. Cardiopulmonary abnormality
B. Effort to blow off CO2 & increase blood pH
C. PPHN
D. Idiopathic reasons
B. since normal findings most likely not cardiopulmonary problem but just an effort to increase pH & remove CO2
82
If you hear bowel sounds in the chest the most likely diagnosis is diaphragmatic hernia, but a differential diagnosis could be?
Pneumothorax, especially if scaphoid abdomen is present as this is a sign
83
```
When you have the classic signs of meconium aspiration & breath sounds are decreased you should also consider other clinical findings of:
I. Hyperexpansion of chest
II. Atelectasis
III pneumothorax
IV. pneumonia
A. I, II
B. I, II, IV
C. I, II, III
D. any are just as likely
```
C. meconium aspiration: you should also consider hyperexpansion of chest, atelectasis, pneumothorax
84
```
If you suspect or diagnose PPHN you may want to rule out a differential diagnosis of?
I. Pneumothorax
II. Atelectasis
III. Polycythemia
IV. Congenital heart defect
A. I, II
B. I, IV
C. III, IV
D. IV only
```
III, IV
| PPHN: you should consider polycythemia, hypothermia, hypoglycemia or hypomg, heart defect, right to left shunt
85
```
When you suspect RDS another condition commonly associated with this is?
A. PPHN
B. Secondary Apnea
C. Transient tachypnea
D. Diabetic mothers
```
D. Diabetic mothers
86
```
What type of breath sounds are associated with apnea of prematurity?
A Diminished or absent
B. Crackles
C. grunting
D. Normal
```
D. Normal breath sounds
87
What is correct about PMI:
I. Position on chest wall in which cardiac impulse seen
II. Viewed easily in newborns due to thin, flexible chest wall
III. Located close to sternal border
IV Pneumothorax will cause a shift in PMI away form affected side
A. I, II
B. I, IV
C. I, II, IV
D. all of the above
D. All are correct
88
```
In a pneumothorax what finding would you see when using transillumination technique
I. Irregular area of light
II. Glowing area through chest wall
III. Pink on unaffected side
IV. Pink on affected side
A. I, II, IV
B. I, II, III
C. II, IV
D. I, II only
```
A. I, II, iV
89
T or F: Heart murmurs are rare following birth but if present are associated with congenital heart defect
F: Heart murmurs are common & normally are transient
90
```
A bounding pulse felt on a neonate may mean:
I. Open ductus arteriosus
II. Low cardiac output
III. Shunting
IV. Shock
A. II, III, IV
B. II, IV
C. I, III
D. All of the above
```
C. Bounding pulse: shunting: right to left; patent ductus arteriosus
A weak pulse indicates possibly low cardiac output or shock
91
T or F: Brachial & Femoral pulses should be equal in intensity
True
92
When measuring pre-ductal sites vs post ductal with pulse OX when preductal higher can indicate presence of?
PPHN, or R-L ductal shunting
93
______ is a bowel infection characterized by sepsis, obstruction, ascites, & significant mortality; abdominal distention may be present
Necrotizing enterocolitis
94
_______ is often seen with a scaphoid, hollowed or unusually flattened diaphragm.
Congenital diaphragmatic hernia
95
The umbilical chord has ___ vessels; ____ umbilical arteries; ______ vein.
3 vessels; 2 arteries that are thick walled; 1 vein that is thin
96
What surrounds the arteries & veins of umbilical chord?
Whartons jelly
97
```
Examining this on the neonates head can indicate genetic abnormalities if posteriorly rotated or low set.
A. Ears
B. Eyes
C. Nose
D. A & B
```
A. Ears
98
T or F: When you alternately occlude each nostril you can check for an incomplete opening into the nasopharynx due to membranous or bony structures.
True: this condition is called choanal atresia: if bilateral will need to intubate via oral airway
99
T or F: Variations in patterns of skin folds & palm prints can indicate a disorder such as Down Syndrome & usually observed via the simian crease.
True: The Simian Crease is a single transverse crease across palm instead of the two normally seen across the palm. Commonly seen in Down Syndrome but in 5-10% of cases can be seen in normal individuals
100
T or F: Crying in piercing, high pitched way indicates RDS.
False: Often in respiratory distress syndrome you may hear grunting cry; piercing, high pitched indicates neurologic injury, drug withdrawal, or increased intracranial pressure
101
T or F: Infants with normal tone will maintain extremities in flat position at rest.
False: they maintain a flexed position at rest
102
_____ is a reflex that occurs when head is allowed to fall back slightly, the startle reaction to sound or touch is similar in response.
Moro Reflex
103
When you press a finger against the sole of the foot what occurs?
Toes curve downward, called plantar grasp reflex
104
```
What tests are performed to check for sepsis?
I. Blood culture
II. CBC
III. ABG
IV. Hgb
A. I, II, III
B. I, II, iV
C. I, II
D. II
```
C. I & II blood culture & CBC
105
The WBC of newborn is ______ than adult.
A. Higher
B. Lower
C. Same value
A. Higher
typical value is 18.1 - 18.9 x 1000 (18,000) cells/mm3
(compared to adult at 4,500 - 11, 500)
106
An elevated WBC greater than 25,000 or lowered below 3500 suggest?
Infection
107
Besides the WBC what other lab value may indicate chronic infection?
Platelet count: A lowered count (less than 150,000) associated with chronic infection; platelets also decreased in DIC or disseminated intravascular coagulation
108
A normal platelet count in term newborn in first 3 days of life?
300,000
| Normal range for adult is 150,000-300,000
109
The newborn infant tends to have ______ (increased or decreased) Hgb or Hct at birth.
Increased: Hgb at 1-3 days is 18.5 g/dl (normal adult is 12- 15)
Hct= 56% (Hct in adult normally 3 x Hgb around 40-45%)
110
Glucose measurements are typically a routine screening as many newborns are at risk for _______.
Hypoglycemia
< 45 or > 125 is abnormal
In adult normal glucose is 70-110
111
```
WBC types:
Basophils: Reduced may indicate?
Monocytes: ?
Eosinophils: ?
Neutorphils: ?
Lymphocytes: ?
```
Basophils: reduced may mean allergic reaction, respond to histamine release; mast cells; decrease in allergic response & stress
Monocytes: Fight chronic infection, bacterial infection
Eosinophils: Allergic disorders, they ingest; common in parasitic infections will increase
Neutrophils: Most common, phagocytosis; acute bacterial infection will increase baby cells or bands
Lymphocytes: Fungal infections; autoimmune will increase
112
```
The ideal time to assess gestational age is:
A. first 30 min
B. first hour of life
C. First 12 hours
D. First 24 hrs
```
C. First 12 hours
113
A pale or mottled skin on an infant suggests what condition?
Anemia or hypotension; decreased perfusion
114
A skin color that is ruddy, reddish blue may be associated with?
Polycythemia, or high HCT
115
The presence of vernix abundantly on the skin indicates?
preterm infant or earlier gestational age
116
T or F: Irregular patches of pale blue-black pigmentation over sacrum & buttocks in black & asian infants indicates bruising or trauma.
False: this is normal finding
117
Skin that is pale or white may indicate?
Hypovolemia or blood loss
118
Which of the following statements is False?
A. Mild to moderate jaundice that appears shortly after birth on first day of life is normal
B. A central Hct of 65% or greater is an indicator of polycythemia or neonatal hyperviscosity syndrom
C. Excessive, abundant vernix caseosa is suggestive of preterm infant.
D. Yellow green staining of skin, nails & umbilical cord is suggestive of meconium staining
A. Mild to moderate jaundice is unusual on first day of life; becomes common after first day
119
```
An infant whose femoral pulses are weaker than radial or brachial should be evaluated for
A. patent ductus arteriosus
B. Hypoplastic left heart syndrome
C. Coarctation of the aorta
D. Tetralogy of Fallot
```
C. Coarctation of the aorta
120
When reading to pulse ox probes on newborn; On the right wrist it shows 95% on room air; On left foot says 84% on room air; this is suggestive of
A. Normal cardiopulmonary function
B. Anemia
C. RDS
D. Significant shunting via a patent ductus arteriosus
D. Shunting
121
```
A newborn with respiratory distress with profoundly diminished breath sounds on left & a scaphoid or hollow appearance of abdomen; they should be evaluated for:
A. Diaphragmatic hernia
B. Omphalocele
C. Hypoplastic left heart syndrome
D. RDS
```
A. Diaphragmatic hernia
122
A newborn is observed to have a small, receding lower jaw, a tongue that seems too large for the mouth, slight cleft palate & is in respiratory distress; the best immediate action is
A. insert appropriately sized oral airway
B. Bag/Mask ventilation with 100% O2
C. Continue to observe & monitor as this type of defect cannot be corrected
D. Place infant in prone position
A. Oral airway
123
```
The minimal platelet count in newborn is:
A. 25,000
B. 50,000
C 100,000
D. 150,000
```
D. 150,000
124
```
When examining the chest wall an increased anteroposterior diameter, abnormal shape, or muscular weakness may indicate?
A. Severe bronchopulmonary dysplasia
B. RDS
C. PPHN
D. Diaphragmatic hernia
```
A. Bronchopulmonary dysplasia
125
```
Compensatory measures for infants & young children to decrease WOB include:
I. Head bobbing
II. Nasal Flaring
III. Grunting
IV. Hyperventilation
A. II, III
B. I, II, III
C. II, III, IV
D. All of the above
```
B. head bobbing, nasal flaring & grunting
126
In newborns, FRC or the resting volume of lungs at end expiration is
A. lower
B. higher
A. lower frc due to very compliant chest wall; preterm infants with RDS have abnormally low FRC due to alveolar collapse
127
```
RDS may result in:
I. low lung volume
II. low compliance
III. increased WOB
IV Lower FRC
A. I, II
B. I, III
C. I, II, III
D. All of the above
```
D. all of the above
