Quiz 19 - Neonatology

Question 1

A newborn born between ___ and ___ weeks of gestation is described as term.

A. 36, 38

B. 40, 42

C. 42, 44

D. 38, 42

Answer 1

D. 38, 42

Question 2

You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant’s abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The MOST appropriate intervention involves:

A. suctioning the oropharynx.

B. manual gastric decompression.

C. inserting an orogastric tube.

D. intubating immediately.

Answer 2

C. inserting an orogastric tube.

Question 3

Which of the following statements regarding the Apgar score is correct?

A. The Apgar score is determined on the basis of the newborn’s condition at 2 and 10 minutes after birth.

B. If resuscitation is needed, it should commence immediately after you obtain the 1-minute Apgar score.

C. A newborn with a heart rate of greater than 80 beats/min would be assigned a score of 2 on the Apgar score.

D. If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.

Answer 3

D. If resuscitation is necessary, the Apgar score is completed to determine the result of the resuscitation.

Question 4

The initial steps of newborn resuscitation include:

A. assessment of pulse rate.

B. proper positioning.

C. positive-pressure ventilation.

D. free-flow oxygen.

Answer 4

B. proper positioning.

Question 5

Signs of hypovolemia in the newborn include all of the following, EXCEPT:

A. weak central pulses.

B. persistent pallor.

C. persistent bradycardia.

D. persistent acrocyanosis.

Answer 5

D. persistent acrocyanosis.

Question 6

When suctioning the newborn’s oropharynx to clear secretions prior to intubation, it is MOST important to:

A. monitor the newborn’s heart rate.

B. assess pulse oximetry and capnography.

C. limit suctioning to 15 seconds.

D. use a flexible suction catheter.

Answer 6

A. monitor the newborn’s heart rate.

Question 7

Newborn hypoglycemia is defined as a blood glucose level lower than:

A. 60 mg/dL.

B. 45 mg/dL.

C. 50 mg/dL.

D. 55 mg/dL.

Answer 7

B. 45 mg/dL.

Question 8

Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will MOST likely cause improvement in this newborn’s condition?

A. 0.06 mg of epinephrine

B. 6.5 mL of 10% dextrose

C. 0.3 mg of naloxone

D. 32 mL of normal saline

Answer 8

D. 32 mL of normal saline

Question 9

When an atrial septal defect is present:

A. deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood.

B. blood is allowed to bypass the right ventricle and lungs due to the fetus’s lungs being filled with fluid.

C. the heart must push harder to force blood flow past a narrowed aorta, resulting in increased afterload.

D. blood flow to the lungs is significantly decreased, which leads to severe hypoxemia.

Answer 9

A. deoxygenated blood is able to shift from one atrium to the other and mix with oxygen-rich blood.

Question 10

Common causes of respiratory distress in the newborn include:

A. mucous obstruction of the nose.

B. unrecognized metabolic alkalosis.

C. maternal use of a narcotic analgesic.

D. persistent pulmonary hypotension

Answer 10

A. mucous obstruction of the nose.

Question 11

Mortality and morbidity are high among infants who are delivered at 24 weeks’ gestation, usually because of:

A. infection and hypothermia.

B. metabolic and immune deficiencies.

C. congenital heart defects.

D. respiratory and neurologic problems.

Answer 11

D. respiratory and neurologic problems.

Question 12

Chest compressions are indicated in the newborn if its heart rate remains less than ____ beats/min despite
effective positive-pressure ventilations for ____ seconds.
answer.

A. 80, 30

B. 60, 30

C. 80, 90

D. 60, 90

Answer 12

A. 80, 30

Question 13

You have just delivered a little girl who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, she remains acrocyanotic and is not crying. You should:

A. determine the newborn’s Apgar score.

B. resuction her mouth for up to 10 seconds.

C. begin assisting her ventilations at once.

D. open her airway and assess respirations.

Answer 13

D. open her airway and assess respirations.

Question 14

The quickest way to prevent newborn hypothermia involves:

A. thoroughly drying the newborn after birth.

B. administering warmed IV fluids.

C. administering warmed, humidified oxygen.

D. applying a hot water bottle to the groin area.

Answer 14

A. thoroughly drying the newborn after birth.

Question 15

You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn’s heart rate remains below 60 beats/min. You should:

A. continue bag-mask ventilations and initiate chest compressions.

B. start a peripheral IV line and give 4 mEq of sodium bicarbonate.

C. try tactile stimulation as you continue bag-mask ventilations.

D. cannulate the umbilical vein and give 0.5 mL of epinephrine.

Answer 15

A. continue bag-mask ventilations and initiate chest compressions.

Question 16

Causes of delayed fetal transition include all of the following, EXCEPT:

A. acidosis.

B. hypothermia.

C. meconium aspiration.

D. birth at 41 weeks.

Answer 16

D. birth at 41 weeks.

Question 17

Signs of a diaphragmatic hernia include all of the following, EXCEPT:

A. noted increased work of breathing.

B. a scaphoid or concave abdomen.

C. audible bowel sounds in the chest.

D. bilaterally absent breath sounds.

Answer 17

D. bilaterally absent breath sounds.

Question 18

Tetralogy of Fallot is a combination of four heart defects, including:

A. atrial septal defect.

B. tricuspid atresia.

C. right ventricular hypertrophy.

D. coarctation of the aorta.

Answer 18

C. right ventricular hypertrophy.

Question 19

During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment of the newborn reveals that it is active, has a strong cry, and has a heart rate of 110 beats/min. You should:

A. preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation.

B. ensure that the infant is warm and dry, and provide continuous monitoring.

C. avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an ET tube.

D. deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator.

Answer 19

B. ensure that the infant is warm and dry, and provide continuous monitoring.

Question 20

When fever is suspected in the newborn, you should:

A. observe for the presence of a rash.

B. assist ventilations with a bag-mask device.

C. administer acetaminophen or ibuprofen.

D. quickly lower the newborn’s body temperature.

Answer 20

A. observe for the presence of a rash.

Question 21

The MOST common etiology for bradycardia in a newborn is:

A. untreated acidosis.

B. occult hypovolemia.

C. severe hypoxia.

D. increased vagal tone.

Answer 21

C. severe hypoxia.

Question 22

Which of the following is NOT an antepartum risk factor that increases the potential that a newborn may require resuscitation?

A. Prolapsed cord

B. Polyhydramnios

C. Multiple gestations

D. Preeclampsia

Answer 22

A. Prolapsed cord

Question 23

You are assisting in the delivery of a baby. After the baby’s head emerges from the vagina, you should quickly assess for the presence of a nuchal cord and then:

A. administer free-flow oxygen.

B. assess for facial cyanosis.

C. dry its face to stimulate breathing.

D. suction its mouth and nose.

Answer 23

D. suction its mouth and nose.

Question 24

You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather in the vicinity. A peripheral IV line has been established in the antecubital vein and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn’s heart rate suddenly drops more. You should:

A. administer 0.1 to 0.3 mL/kg of epinephrine rapid IV push.

B. abort the intubation attempt and continue ventilations.

C. ensure that chest compressions are of adequate rate and depth.

D. continue the intubation attempt and administer atropine.

Answer 24

B. abort the intubation attempt and continue ventilations.

Question 25

How much naloxone should you give to a 6.5-pound newborn with respiratory depression secondary to maternal narcotic administration?

A. 0.3 mg

B. 0.5 mg

C. 0.6 mg

D. 0.4 mg

Answer 25

A. 0.3 mg