CCPR 2023 NNP Test

CCPR 2023 NNP Test Limited horizontal nystagmus resolves by: a. 1-2 months of age b. 2-3 months of age c. 3-4 months of age - ✔✔c. 3-4 months of age Infants with bronchopulmonary dysplasia have increased energy need ...

CCPR 2023 NNP Test Limited horizontal nystagmus resolves by: a. 1-2 months of age b. 2-3 months of age c. 3-4 months of age - ✔✔c. 3-4 months of age Infants with bronchopulmonary dysplasia have increased energy needs, often as much as: a. 10-20% b. 20-40% c. 40-60% - ✔✔b. 20-40% What are the protein requirements for term infants? a. 2 g/kg/day b. 3 g/kg/day c. 4 g/kg/day - ✔✔b. 3 g/kg/day Preterm may require 3.5-4 g/kg/day. Minimum is 2 g/kg/day A normal blood finding in the term neonate on day one of life is: a. a hematocrit of 65% b. a hemoglobin level of 18 g/dL c. erythrocyte count of 3 million - ✔✔b. a hemoglobin level of 18 g/dL The principle action of volume expanders during resuscitation is to: a. address myocardial decompensation b. facilitate peripheral vasoconstriction c. maintain cardiac output and blood pressure - ✔✔c. maintain cardiac output and blood pressure A two day old neonate has an abdominal mass. The most likely cause is: a. adrenal hemorrhage b. polycystic kidney c. volvulus - ✔✔b. polycystic kidney Renal is the most frequent cause of abdominal masses in newborns. There is an increased risk of hypochloremia in neonates who: a. are asphyxiated at birth b. had prolonged diarrhea c. have been over-treated with diuretics - ✔✔c. have been over-treated with diuretics A decision to provide morphine to a dying infant is framed by the principle of: a. autonomy b. nonmaleficence c. justice - ✔✔b. nonmaleficence justice = equal opportunity to all autonomy = allowed to take direction in accordance to own/best self interest The first sign of hypothermia in a critically ill neonate is a drop in which temperature? a. axillary b. rectal c. skin - ✔✔c. skin A preterm infant is born with cutaneous pinkish-gray granulomas. This finding is characteristic of infection with: a. candida albicans b. listeria monocytogenes c. toxoplasma gondii - ✔✔b. listeria monocytogenes Rib fractures are noted on routine chest x-ray on a 3 month old premature infant. The most likely cause of this finding is: a. congenital hypoparathyroidism b. inadequate calcium and phosphorus intake c. vitamin D deficiency due to malabsorption - ✔✔b. inadequate calcium and phosphorus intake The drug of choice when treating opioid withdrawal is: a. diazepam b. oral morphine c. pheobarbital - ✔✔b. oral morphine A neonate with acute renal failure requires short acting narcotic analgesic. The best drug to use in this situation is: a. fentanyl b. morphine c. sufentanil - ✔✔a. fentanyl A term neonate who was born to an HBsAg positive mother is being discharged three months after birth following surgery for a cardiac condition. The mother asks when the next Hep b immunization should be given. The NP should advise that it be given at: a. four months b. six months c. twelve months - ✔✔b. six months A term, small for gestational age neonate at 4 hours of life is tachypneic, plethoric, lethargic, and has a blood sugar of 53 mg/dL and a central hematrocrit of 70%. The most likely diagnosis is: a. hyperviscosity b. hypocalcemia c. hypoglycemia - ✔✔a. hyperviscosity A factor that would result in increased insensible water loss in neonates is: a. hypothermia b. phototherapy c. postmaturity - ✔✔b. phototherapy A neonate has a flat reddish birthmark with sharply delineated edges on the nape of the neck. When pressure is applied to the birthmark, there is minimal blanching. This finding is consistent with: a. infantile hemangioma b. nevus simplex c. port wine stain - ✔✔c. port wine stain nevus simplex does blanch. A neonate is born to a mother with a positive TB test but no signs of active disease. Management of this neonate should include: a. initiate medication therapy on mother and infant b. no special evaluation or therapy c. separate mother and neonate until status can be confirmed - ✔✔b. no special evaluation or therapy The standard of care for neonatal nursing is judged according to the standard of care: a. locally b. nationally c. regionally - ✔✔b. nationally Which of the following is a contraindication to breastfeeding? a. maternal hepatitis B b. maternal HIV c. maternal HSV - ✔✔b. maternal HIV A newborn presents at birth with a palpable, distended bladder and poor urinary stream. Based on these symptoms, which of the following renal defects should be considered? a. polycystic kidney disease b. posterior urethral valves c. ureteropelvic junction obstruction - ✔✔b. posterior urethral valves A 3 day old neonate has hematuria, decreased urine output, and a platelet count of 60,000. Which of the following is the most likely diagnosis? a. renal parenchyma disease b. renal tubular acidosis c. renal vein thrombosis - ✔✔c. renal vein thrombosis A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and an arterial blood gas reveals the following: pH 7.30, CO2 60, O2 60, HCO3 24, -2. When interpreting this arterial blood gas, it should be recognized that a. the metabolic component is abnormal b. the primary problem is respiratory c. tissue oxygen supply is inadequate - ✔✔b. the primary problem is respiratory When both proximal and distal arm weakness occur it is termed: a. Erb's palsy b. Klumpke's palsy c. Total plexus palsy - ✔✔c. total plexus palsy A 32 week gestation infant with decreased renal function develops systemic candidiasis. The best choice of antifungal therapy for this baby is: a. Amphotericin B lipid complex b. fluconazole c. flucytosine - ✔✔a. amphotericin B lipid complex A 12 hour old male infant appears hypotonic with generalized muscle weakness and absent deep tendon reflexes. There is no family history of neuromuscular disease. Which of the following would be the first step in diagnostic evaluation? a. creatinine phosphokinase (CPK) level b. electromyography c. muscle biopsy - ✔✔a. CPK level A 2 day old male is persistently bleeding 12 hours post circumcision. The cause of this bleeding is most likely a. factor VIII deficiency b. factor V deficiency c. poor technique - ✔✔a. factor VIII deficiency hemophilia A 780g infant has a bilirubin level of 17 mg/dL at 24 hours of age. The treatment of choice is: a. exchange transfusion b. exchange transfusion and phototherapy c. phototherapy - ✔✔b. exchange transfusion and phototherapy A 8 hour old neonate is irritable and tremulous. These findings are consistent with withdrawal from in utero exposure to: a. cocaine b. heroin c. methadone - ✔✔b. heroin --> quickly seen after birth The x-ray of a neonate with suspected necrotizing enterocolitis shows pneumoperitoneum. This finding is consistent with a. air in the portal venous system b. bowel perforation c. diffuse gaseous intestinal distention - ✔✔b. bowel perforation Infants born to mothers with myasthenia gravis a. are at risk for respiratory failure b. will have symptoms resolve spontaneously around 6 months of age c. will present with symptoms within first 12 hours of life - ✔✔a. are at risk for respiratory failure give anticholinesterase --> neostigmine methylsulfate A factor that usually differentiates the pathophysiology between meconium ileus and meconium plug syndrome is a. bilious vomiting b. enzymatic deficiency c. intestinal obstruction - ✔✔b. enzymatic deficiency A neonate has had several episodes of vomiting. The arterial blood gas results are: pH 7.53; PCO2 42 mmHg; PO2 56 mmHg; Base excess 33 mEq/L. This blood gas represents: a. borderline normal findings b. compensated metabolic acidosis c. metabolic alkalosis - ✔✔c. metabolic alkalosis A late preterm infant presents with recurrent oral thrush. The most likely source would be a. breast b. nipple c. pacifier - ✔✔a. breast A neonate with coarctation of the aorta develops intractable congestive heart failure, acidosis, oliguria, and hypertension. The appropriate action is immediate: a. cardiac catherization b. IV digoxin c. place neonate in a knee chest position - ✔✔a. cardiac catherization A common complication of percutaneous central line include a. cardiac perforation b. catheter entrapment c. extravasation - ✔✔c. extravastation A risk factor for bronze baby syndrome is a. cholestasis b. hypothyroidism c. galactosemia - ✔✔a. cholestasis The mandatory diagnostic test for infants suspected of having congenital syphilis is: a. CSF VDRL b. fluorescent treponemal antibody absorption c. serum VDRL - ✔✔a. CSF VDRL An increase in cerebral blood flow can be expected in association with: a. decreased pCO2 b. decreased PaO2 c. decreased K+ level - ✔✔b. decreased PaO2 --> trying to get blood to brain Infants with Beckwith-Wiedemann Syndrome are at risk for: a. detached retinas b. failure to thrive c. Wilm's tumor - ✔✔c. Wilm's tumor A characteristic that is present in both omphalocele and gastroschisis is: a. high incidence of congenital malformations b. nonrotation of the infant c. peritoneal sac covering the defect - ✔✔b. non-rotation of the intestine A & C both traits of omphalocele On gestational age examination, a neonate falls below the expected range for weight, length, and head circumference. A likely antecedent for this growth aberration is: a. intrauterine congenital infection b. nutritional deficiency c. uteroplacental insufficiency - ✔✔a. intrauterine congenital infection --> cause of symmetric IUGR. Brain reperfusion injury occurs after oxygenation of perfusion has been restored for a. 4-7 hours b. 8-16 hours c. 24 hours - ✔✔b. 8-16 hours An increased incidence of low serum calcium levels occur in neonates who are: a. dehydrated b. have a history of asphyxia c. have adrenal insufficiency - ✔✔b. have a history of asphyxia Also, inadequate stores and IDM Glucose use by the brain is greater in infants who are a. asymmetrically growth restricted b. jaundiced c. post-term - ✔✔a. asymmetrically growth restricted Which milk protein is easiest to digest? a. casein b. lysozyme c. whey - ✔✔c. whey milk initially 80:20 whey:casein then 60:40 Cystic Fibrosis is characterized by: a. foul smelling meconium b. meconium ileus c. mucous plug - ✔✔b. meconium ileus Increased left atrial pressure is responsible for what circulatory change at birth? a. constriction of the ductus arteriosus b. elimination of right-to-left shunting at the foramen ovale c. increased systemic pressure - ✔✔b. elimination of right-to-left shunting at the foramen ovale What size endotracheal tube should be available to resuscitate a 36 week 2500gm newborn? a. 2.5 mm b. 3.0 mm c. 3.5 mm - ✔✔c. 3.5 mm The correct position for cardiac compressions during neonatal resuscitation is shown at point a. A b. B c. C - ✔✔c. C The recommendation regarding thee administration of Narcan (naloxone) to the newborn with respiratory depression secondary to maternal administration of narcotics is to a. administer at 15 minutes after birth b. administer as soon as possible c. avoid administration - ✔✔c. avoid administration Agenesis of the corpus callosum commonly occurs with which of the following disorders of brain formation? a. Baritser-Winter syndrome b. Dandy-Walker syndrome c. Zellweger syndrome - ✔✔b. Dandy-Walker syndrome What process of pharmacokinetics is most important to consider when prescribing a drug that has a narrow therapeutic range? a. bioavailability b. distribution c. metabolism - ✔✔a. bioavailability --> amount of drug dose that reaches the systemic circulation A term, healthy infant, who has been breastfeeding well develops jaundice on day 5 of life. The bilirubin peaks on day 14. This type of jaundice is called a. breast milk jaundice b. cholestasis c. physiologic jaundice - ✔✔a. breast milk jaundice The preferred method of diagnosing HIV infection in the neonate is a. DNA PCR b. plasma viral RNA c. viral culture - ✔✔a. DNA PCR The best management of a neonate with a symptomatic patent ductus arteriosus at 2 days of age is: a. fluid restriction b. ibuprofen lysine c. surgical ductal ligation - ✔✔b. ibuprofen lysine if asymptomatic, could do fluid restriction Expected muscle tone development in a 28 week neonate would include a. good extension with a tendency to adduct b. palmar grasp reflex c. tonic neck reflex - ✔✔b. palmar grasp reflex A benefit of habituation is a. hand to mouth coordination b. language development c. protection from overstimulation - ✔✔c. protection from overstimulation For newborns with meconium aspiration syndrome, treatment would be directed at a. improving oxygenation b. suctioning meconium from trachea c. surfactant replacement therapy - ✔✔a. Improving oxygenation A term neonate at three days of age has unequal pupils, slow response to light, and tense fontanelles. Labored retractions are present. These finding are consistent with a. intracerebellar hemorrhage b. subarachnoid hemorrhage c. subdural hemorrhage - ✔✔c. subdural hemorrhage Infants at risk for a false negative when screened for congenital adrenal hyperplasia are a. 1-2 days old b. females c. small for gestational age - ✔✔a. 1-2 days old The preferred approach for evaluation of the anatomy of the obstructing tissue in choanal atresia is a. computerized tomography b. ultrasound c. x-ray - ✔✔a. computerized tomography The effects of maternal smoking include a. congenital heart defects b. fetal growth acceleration c. prematurity - ✔✔c. prematurity Over half of abdominal masses that present during the newborn period originate in which system? a. GI b. hepatosplenobiliary c. renal - ✔✔c. renal Following a traumatic delivery, a neonate's arm falls motionless along the side of the body and is rotated inwards. Extension of the forearm is present but there is no limitation on the movement of the hand. Once localized edema and pain diminished, the neonate should be referred to for a. casting of the affected limb b. physical therapy c. surgical repair - ✔✔b. physical therapy --> even in FTN Physiologic anemia of infancy is characterized by a decline in hemoglobin within the first a. 2 days of birth b. 2 weeks of birth c. 2 months of birth - ✔✔c. 2 months of birth A thyroid screen of a 36 hour preterm neonate shows low T4 and elevated TSH. This neonate should: a. be tested for maternal-thyroid stimulating antibodies b. have confirmatory serum testing c. have serum thyroid releasing hormone level - ✔✔b. have confirmatory serum testing is just a thyroid screen! Indicative of hypothyroidism, should be treated to prevent neurological damage The difference in human milk from mother's of premature infants when compared to that of mature human milk is a lower concentration of a. calcium b. carbohydrates c. protein - ✔✔b. carbohydrates Which of the following statements describes a practice fundamental to the implementation of an interdisciplinary developmental care team? a. care is delivered at regular timely intervals allowing adequate rest time b. infants are prepared for care with hand containment prior to care procedure c. minimize caloric expenditure by limiting movement of extremities with blanket rolls and other positioning aids. - ✔✔b. infants are prepared for care with hand containment prior to care procedure the most commonly seen neck mass is: a. cystic hygroma b. goiter c. thyroglossal duct cyst - ✔✔a. cystic hygroma At six hours of age after c/s a full-term male neonate demonstrates mild hypoxemia requiring 30% FiO2 and mild acidemia. Chest x-ray reveals hyperexpansion with streaky infiltrates. The suspected diagnosis is: a. early RDS b. neonatal pneumonia c. transient tachypnea of the newborn - ✔✔c. transient tachypnea of the newborn The parents of a 4 year old daughter must tell her that her newborn baby sister has died. Considering the cognitive understanding of the child, they should a. explain the situation without using the word "died" b. not let the child see the parents are upset c. provide opportunities for repetitive explanations - ✔✔c. provide opportunities for repetitive explanations A chest x-ray of a neonate shows low lung volumes and a fine reticulogranular pattern of air density. This is consistent with: a. premature lungs b. meconium aspiration c. neonatal pneumonitis - ✔✔a. premature lungs The effectiveness of nitric oxide as a treatment for pulmonary hypertension is dependent on a. pulmonary ventilation-perfusion ratio b. the extent of right-to-left shunting c. the severity of parenchymal lung disease - ✔✔c. the severity of parenchymal lung disease Energy intake for growth with parenteral nutrition are a. 30-50 kcal/kg/day b. 90-100 kcal/kg/day c. 105-130 kcal/kg/day - ✔✔b. 90-100 kcal/kg/day The optimal time to perform a gestational age assessment for the neonate born at 26 weeks gestation is: a. 48-72 hours of age b. after 72 hours of age c. within 12 hours of age - ✔✔c. within 12 hours of age Diagnosis of hypertelorism or hypotelorism is primarily based on the measurement represented by point a. A b. B c. C - ✔✔a. A how close or far away the eyes are from each other Osteopenia of prematurity in the very low birthweight neonate is most commonly caused by a. abnormal vitamin metabolism b. decreased dietary intake of vitamin D c. insufficient intake of calcium and phosphorus - ✔✔c. insufficient intake of calcium and phosphorus Initial broad-spectrum treatment of suspected or confirmed bacterial early onset sepsis should include an aminoglycoside such as gentamicin and what other antibiotics for synergy? a. ampicillin b. cefotaxime c. vacomycin - ✔✔a. ampicillin b is a 3rd generation cephalosporin, similar to gent and c is used for LOS Physiologic characteristics of Ebstein's Anomaly include a. bicuspid aortic valve b. downward displacement of the tricuspid valve c. severe pulmonary parenchymal disease - ✔✔b. downward displacement of the tricuspid valve Calculation of the maintenance dose of a drug depends primarily on a. clearance b. half-life c. volume of distribution - ✔✔b. half-life Positive pressure ventilation with 21% oxygen is administered at delivery, and the heart rate after 30 seconds is 102 beats per minute and increasing. The next intervention is to a. continue ventilation for a minimum of one minute b. discontinue ventilation c. observe for spontaneous respirations, then discontinue ventilation - ✔✔c. observe for spontaneous respirations, then discontinue ventilation Vitamin K facilitates the coagulation process by a. converting inactive precursors into active clotting factors b. interplaying with bilirubin for synthesis of coagulation factors c. promoting proliferation of intestinal flora for vitamin K metabolism - ✔✔a. converting inactive precursors (II, VII, IX, X) into active clotting factors Amniofusion during labor may minimize the morbidity caused by a. cord compression b. head compression c. placenta previa - ✔✔a. cord compression A clinical sign that appears in the neonate with congenital heart disease that reflects development of pulmonary edema is a. cyanosis b. dyspnea c. tachypnea - ✔✔c. tachypnea The organism most commonly responsible for early-onset bacterial infection in the neonate is a. E-coli b. GBS c. MRSA - ✔✔b. GBS The infant of a diabetic mother presents with signs of low intestinal obstruction. Following contrast studies the infant promptly evacuates the barium and begins passing stool. The most likely diagnosis is A. Hirschprung's disease b. meconium plug syndrome c. small left colon - ✔✔c. small left colon Which immunologic component is important in graft-versus-host disease? a. monocytes b. neutrophils c. T-lymphocytes - ✔✔c. T-lymphocytes A major advantage of US over other diagnostic imaging methods is a. there is no radiation exposure b. two dimensional visualization of anatomy c. utilizes radio waves to evaluate tissue structure - ✔✔a. there is no radiation exposure Ventricular septal defect should be suspected in the neonate if a. a pronounced murmur is heard b. cyanosis is present c. the heart is boot shaped - ✔✔a. a pronounced murmur is heard Unresolved grief in the parent of a child with a disability that constantly reminds them of the loss of a healthy child is called a. anticipatory grief b. chronic grief c. uncomplicated grief - ✔✔b. chronic grief Neonatal hypocalcemia is most likely to occur with a. hypermagnesium b. placental insufficiency c. postmaturity - ✔✔b. placental insufficiency SGA, IUGR, IDM, etc. Brushfield's spots are associated with a. osteogenesis imperfecta b. rubella c. trisomy 21 - ✔✔c. trisomy 21 osteogenesis = blue sclera rubella = cataracts Hyperkalemia in a 2 hour old very low birth weight neonate with normal urine output is likely due to a. a shift in potassium from the intracellular to the extracellular compartment b. distal tubular dysfunction c. limited reabsorption capacity of the tubule - ✔✔a. a shift in potassium from the intracellular to the extracellular compartment intracellular increases as GA increases. Compared to indomethacin, ibuprofen reduces the incidence of side effects in which system? a. GI b. hepatic c. renal - ✔✔c. renal The most important site of medication biotransformation is a. GI tract b. kidneys c. liver - ✔✔c. liver Biotransformation of a drug into an inactive state to be metabolized out majority occurs in the liver Th most common cause of neonatal hyperthyroidism is a. graves disease b. pituitary adenomas c. thyroiditis - ✔✔a. graves disease Determine the apgar score of the following neonate: one minute: pale; 40 bpm; no response; limp; weak and irregular five minutes: pink with blue extremities; 90 bpm; grimace; limp; weak and irregular a. 2 at one minute and 4 at 5 minutes b. 2 at one minute and 5 at 5 minutes c. 3 at one minute and 6 at 5 minuts - ✔✔a. 2 at one minute and 4 at 5 minutes Gentamicin resistant organisms are present in a nursery. The appropriate treatment of a neonate with early onset would be ampicillin and a. amikacin b. cefotaxime c. vancomycin - ✔✔b. cefotaxime On the second day of life, a previously healthy term neonate develops apnea and has a mottled appearance. Lab results are: WBC 5500 Segs 6 Bands 15 Lymphs 65 Monos 10 Eos 4 CSF WBC 110 RBC 100 glucose 8 protein 270 CSF gram stain positive for gram negative bacilli Recommended therapy is: a. ampicillin and cefotaxime b. ampicillin and gentamicin c. vancomycin and cefotaxime - ✔✔a. ampicillin and cefotaxime amp because it's early onset sepsis and cefotaxime because it has better meningitis coverage A neonate is born with meconium stained fluid, has good respiratory effort, good tone and a heart rate of 102 bpm. The most appropriate action is: a. clear mouth and nose of secretions b. suction mouth and trachea c. intubate and suction trachea - ✔✔a. clear mouth and nose of secretions Continued posturing of a limb is characteristic of: a. clonic seizures b. myoclonic seizures c. tonic seizures - ✔✔c. tonic seizures A neonate is oliguric. A 10-20mL/kg body weight test dose of isotonic solution is given IV over 1 hour. If the problem is prerenal, the urine output should: a. decrease b. increase c. remain unchanged - ✔✔b. increase Patients with respiratory distress syndrome demonstrate a characteristic grunt during expiration. This is an attempt to: a. decrease negative intrathoracic pressure b. inflate non-compliant lungs c. maintain functional residual capacity - ✔✔c. maintain functional residual capacity The neonate in the early stage of congestive heart failure may increase their heart rate to compensate for: a. decreased cardiac output b. pulmonary edmea c. redistribution of blood flow - ✔✔a. decreased cardiac output CO = SV x HR. Infants can only affect HR. with pulmonary edema - tachypnea When introducing trophic feedings to the premature infant, the NNP should recognize that a. development of the intrinsic GI immune system will be enhanced b. dilution of breastmilk or formula with sterile water is preferred c. trophic feeds increase the risk for NEC - ✔✔a. development of the intrinsic GI immune system will be enhanced An infant is noted to have vertebral anomalies, a single umbilical cord, and a TE fistula. What studies should you consider obtaining? a. echocardiogram b. eye exam c. renal US - ✔✔c. renal US b/c of single UA The reason administration of IV 10% calcium gluconate is utilized in the management of hyperkalemia in the neonate is to: a. facilitate renal excretion of potassium b. increase potassium influx into the cells c. stabilize the myocardium - ✔✔c. stabilize the myocardium One of the most beneficial tests in the initial evaluation of the neonate with suspected congenital heart disease is: a. four-extremity blood pressure b. pulse oximetry c. the hyperoxia test - ✔✔c. the hyperoxia test A newborn exposed to rubeola should be given: a. immunoglobulin b. measles vaccine c. ribavirin - ✔✔a. immunoglobulin Don't give measles because it is a live vaccine Interventions to decrease conductive heat loss in the delivery room include: a. providing additional heat source during the bath b. using transparent plastic covering over the infant c. warmer the incubator mattress - ✔✔c. warming the incubator mattress conductive = touching, so the warmth will go to baby. transparent plastic = evaporative additional heat = convective vs. radiative Through a combined process, the term neonate can increase their metabolic rate by: a. 100-200% b. 200-300% c. 300-400% - ✔✔b. 200-300% A term neonate has a brief history of lethargy and poor feeding. Upon examination, the neonate is noted to be pale, mottled, and diaphoretic. Palpation reveals strong pulses in the upper extremities and diminished pulses in the lower extremities. The following data are obtained: axillary temp 36.6; HR 176; RR 84 bpm; cap refill 5 seconds; urine output 0.2mL/kg/hr. A diagnostic step that is useful is: a. assessing for the presence of a diastolic murmur b. drawing serial blood gases in room air and 100% oxygen c. obtaining blood pressures in all 4 extremities - ✔✔c. obtaining blood pressures in all 4 extremities A term neonate who has just come off mechanical ventilation and begun enteric feedings has developed abdominal distention and bile stained vomiting. An x-ray depicts a small bowel obstruction with soap bubble appearance in the right lower quadrant. These clinical findings and x-ray findings are consistent with: a. hirschprung's disease b. meconium ileus c. NEC - ✔✔b. meconium ileus Compared to morphine, fentanyl citrate may produce: a. bronchospasm b. chest wall rigidity c. tachycardia - ✔✔b. chest wall rigidity A preterm neonate on prolonged furosemide (Lasix) therapy is at increased risk for: a. hypokalemia b. hypophosphatemia c. metabolic acidosis - ✔✔a. hypokalemia is a loop diuretic, holds onto Na and H20, excretes K Perinatal transmission of HIV infection is increased when the mother has a. low bone marrow derived lymphocytes b. low CD4+ lymphocyte count c. postive PCR assay - ✔✔b. low CD4+ lymphocyte count A key principle in resuscitation is that a. maximal pressure should be used for cardiac compressions b. medications are not a substitute for adequate ventilation c. suctioning should be aggressive for optimal outcome - ✔✔b. medications are not a substitute for adequate ventilation always establish adequate ventilation FIRST The AAP recommends discharge of the late preterm infant after a. 24 hours b. 48 hours c. 72 hours - ✔✔b. 48 hours Preterm infants should receive the influenza vaccine at a. 3 months of age b. 6 months of age c. 12 months of age - ✔✔b. 6 months of age Hirschprung's disease occurs due to: a. abnormal small intestine motility b. enzyme deficiency c. ganglion cell deficiency - ✔✔c. ganglion cell deficiency Inborn errors of metabolism should be considered when the infant presentts with a. alkalosis b. hyperglycemia c. seizures - ✔✔c. seizures A characteristic that is common in infants with trisomy 13, 18, and 21 is a. cardiac defects b. hypotonia c. low set ears - ✔✔a. cardiac defects A risk factor for IVH is a. decreased venous pressure b. greater than 41 weeks gestation c. hyperviscosity - ✔✔c. hyperviscosity Synchronized ventilation has been demonstrated to decrease a. duration of ventilation therapy b. mortality c. work of breathing - ✔✔c. work of breathing Infants should not receive fluoride supplements until they are a. 3 months old b. 6 months old c. 9 months old - ✔✔b. 6 months old Infants of diabetic mothers are at increased risk for hypoglycemia because of insulin-stimulated peripheral glucose uptake and a. abnormalities in glucose metabolism b. altered regulation of insulin secretions c. inhibition of gluconeogenesis - ✔✔c. inhibition of gluconeogenesis The rise in glomerular filtration rate after birth can be attributed to: a. elongation of the loops of Henle b. expansion of the filtration surface area c. rise in circulating renin levels - ✔✔b. expansion of the filtration surface area During resuscitation an infant is noted to have weak peripheral pulses, persistent tachycardia, and diminished muscle tone. The most appropriate intervention would be: a. epinephrine 0.1-0.3 mL/kg b. NS 10 mL/kg c. sodium bicarb 2 mEq/kg - ✔✔b. NS 10 mL/kg A statement that characterizes neonatal renal function in the very low birth weight neonate, is that the neonate has an a. inability of the proximal tubule to reabsorb adequate amounts of sodium b. inability to dilute urine to the same degree as the adult c. increased bicarb reabsorption In the proximal tubule - ✔✔a. inability of the proximal tubule to reabsorb adequate amounts of sodium On auscultation of the lungs, a high-pitched sound is heard during expiration. This is consistent with: a. rhonchi b. stridor c. wheezing - ✔✔c. wheezing Maturation of the 25 week gestation neonates skin may take up to how many weeks? a. 2 weeks b. 4 weeks c. 8 weeks - ✔✔c. 8 weeks In premature infants, bilirubin levels generally peak on day a. 3 of life b. 5 of life c. 8 of life - ✔✔b. 5 of life Preterm - Peaks day 5-6 of life term- peaks 3 days of life A neonate born to a mother who developed varicella rash three days prior to delivery should receive a. acyclovir b. IVIG c. VariZIG - ✔✔c. VariZIG Genital ambiguity should prompt the healthcare team to screen for a. congenital adrenal hyperplasia b. hypothyroidism c. pituitary gland disorders - ✔✔a. congenital adrenal hyperplasia A shunt study is performed on a neonate with respiratory distress, and the PaO2 does not change with administration of 100% oxygen. Based on this finding, it can be assumed that: a. continuous positive airway pressure will be helpful b. right-to-left shunting is present c. the neonate has severe lung disease - ✔✔b. right-to-left shunting cardiac issue. A and C would be helpful with respiratory problem. A neonate is born by emergency C/S because of fetal-maternal hemorrhage. At delivery, the infant fails to respond to the steps of resuscitation. The baby is displaying signs of shock. The appropriate intervention would be to administer: a. epinephrine b. sodium bicarb c. volume expanders - ✔✔c. volume expanders A preterm neonate who required resuscitation at birth is admitted to the neonatal intensive care unit. Care of this infant should include: a. insertion of urinary catheter to monitor output b. maintain head in a midline position c. oral feeding to prevent hypoglycemia - ✔✔b. maintain head in a midline position Which of the following is a characteristic of an autosomal recessive disorder? a. it is expressed in the heterozygous state b. parents are phenotypically normal c. there is a 50% risk for each offspring to be affected - ✔✔b. parents are phenotypically normal parents are carriers Most medical and nursing errors occur because of a. lack of education b. non-adhearance to standard of care c. system failures - ✔✔c. system failures When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is a. a cuffed ET tube should be inserted to prevent air leak around the tube b. bag and mask ventilation should be initiated immediately to maximize pulmonary function c. insertion of an endotracheal tube should be done as quickly as possible. - ✔✔c. insertion of an endotracheal tube should be done as quickly as possible. The neurologic consequence of a hemorrhage within the germinal matrix and the ventricular system is a. aqueductal stenosis b. damage to the periventricular white matter c. dilation of germinal matrix - ✔✔b. damage to the periventricular white matter ventricles dilate, not germinal matrix Bullous lesions appear on an infant's skin on DOL 2. This finding is: a. benign b. due to an irritant c. indicative of infection - ✔✔c. indicative of infection staph When giving medical information to parents of a premature sick infant, information should be presented a. cautiously because the infant's outcome is unknown b. directly and honestly but using an individualized balanced approach c. in a hopeful scenario focusing on the positives of the situation - ✔✔b. directly and honestly but using an individualized balanced approach When levels of PEEP are increased, they can worsen acute lung injury due to a. barotrauma b. excessive tidal volume c. low lung volume - ✔✔a. barotrauma While caring for an infant born at 38 weeks GA who was admitted to the NICU to rule out sepsis, the nurse practitioner should understand which of the following related to physiology of thermoregulation? a. heat production in the neonate results from aerobic metabolism b. heat transfer from internal organs to skin surface is decreased in the neonate. c. non-shivering thermogenesis is dependent on availability of glucose - ✔✔c. non-shivering thermogenesis is dependent on availability of glucose A 32 week gestational age male newborn has a 4 cm non-tender mass in the right testicle. Differential diagnosis can be facilitated by: a. palpation b. transillumination c. US evaluation - ✔✔b. transillumination A two day old neonate had no passage of stool since birth. Rectal examination accomplishes evacuation. The neonate shortly after develops abdominal distention. The most appropriate diagnostic test to obtain is: a. abdominal x-ray b. contrast enema c. rectal biopsy - ✔✔c. rectal biopsy potentially has hirschsprung's disease, rectal biopsy would confirm. A 5 day old 1000g preterm neonate is suspected of having hypokalemia. Expected EKG findings are: a. depressed ST segment, flattened T wave b. peaked T wave, absent P wave c. widended QRS complex - ✔✔a. depresed ST segment and flattened T wave B and C are for hyperkalemia A 5 day old infant develops a watery eye discharge that progresses rapidly to purulent exudate. Chlamydia trachomatis conjuncitivitis is diagnosed. The NP should be aware that: a. gentle pressure over nasolacrimial sac results in mucopurulunt drainage b. therapy of choice is oral erythromycin x 14 days c. this patient is at risk for corneal ulceration, perforation, and visual impairment - ✔✔b. therapy of choice is oral erythromycin x 14 days c is gonorrhea