Neonates born to mothers with a seizure disorder are at increased risk for
C. prematurity
Maternal renal adaptation to pregnancy involves an increase in
C. retention of sodium and water
Untreated maternal phenylketonuria can lead to
C. cardiac defects
Unregulated glucose control in a woman with diabetes early in pregnancy can predispose the fetus to
B. congenital anomalies
Neonatal manifestation of systemic lupus erythematosus is attributed to
a. interference with protein synthesis
b. maternal deficiency of autoantibodies and immune complexes c. placental transfer of antibodies to the fetus
c. placental transfer of antibodies to the fetus
Common behavioral manifestations of neonates who were exposed to cocaine in utero include
C. difficulty alternating between alert and drowsy states
In women with multiple sclerosis, expected neonatal outcomes include
C. full term delivery
In a 32 week gestational age neonate, the expected muscle development would include a
A. good grasp reflex
A physical finding consistent with extreme prematurity is
C. sparse lanugo
A neonate born at 36 weeks gestation weighing 3000 gm is at increased risk for
B. increased jaundice
When performing a gestational age assessment, the nurse should recognize that a finding that correlates with advancing gestional age is increased
A. resistance with scarf sign maneuver
Neuromuscular development characteristic of prematurity includes increased
A. popliteal angle
In examining the eye of a black newborn, a bright light directed toward the lens reveals a red-orange color that is reflected back to the examiner. The finding is consistent with
a. an intact lens
b. cateracts
c. retinoblastoma
an intact lens
The Ortolani maneuver can be described as
A. reducing a dislocated femoral head into the acetabulum
During a physical examination of a 29 week gestational age neonate, the grasp reflex is good, but the suck reflex is weak and not synchronized with swallowing. The nurse should recognize that this is due to
B. prematurity
A preterm neonate who required resuscitation at birth is admitted to the neonatal intensive care nursery in stable condition. Care of this infant should include
B. a chest x-ray to rule out pneumothorax
After administration of 100% Fi02 for 10 minutes to an infant with cyanosis of cardiac origin, the nurse would expect the Pa02 to
A. remain the same
A neonate has a flat pink lesion on the face. The lesion has diffusely delineatued borders, and blanching occurs when pressure is applied. The nurse should suspect
B. nevus simplex
A 2500 gm neonate with birth asphyxia develops hypocalcemia. This is most likely a result of increased
B. calcitonin
A neonate is oliguric. A 10-20 ml/kg body weight test dose of isotonic solution is given IV over 1 hour. If the problem is prerenal, the urine output will
a. decrease
b. increase
c. remain unchanged
increase
The maturity of hypertention in infants can be accounted for as a result of
B. umbilical artery catheter complications
Orotracheal intubation is preferable to nasotracheal intubation during acute neonatal resuscitation because
A. it can be performed without additional equipment
When determining the amount of supplemental oxygen to administer in neonatal resuscitation the goal is to
A. generate oxygen free radicals
After an initial resusciation, poor perfusion continues, pulses are thready, and the neonate appears in shock. Dopamine is administered as a continuous IV infusion. The nurse should recognize that
A. benefical effects are dependent on adequate blood volume
A vigorous neonate is born with thick meconium present in the amniotic fluid. After placing the baby on a warmed radiant warmer and positioning the head, the next step in resuscitation should be
B. bulb syringe suctioning
When resuscitating a neonate with suspected diaphragmatic hernia, the nurse should recognize that
B. insertion of an endotracheal tube should be done as quickly as possible to prevent gas from entering the intestines
Prior to administration of sodium bicarbonate for resuscitation, the following should be established
A. adequate ventilation
The priniciple action of epinephrine during resuscitation is to
B. improve plasma and blood volume expansion
There is an increased risk of hyperchloremia in neonates who
B. have been diagnosed with renal tubular acidosis
Neonatal hypocalcemia is most likely to occur with
A. perinatal asphyxia
Hyperkalemia in the very low birth weight neonate with normal urine output during the first few hours of life is mainly due to
C. high efflux of potassium from the intracellular compartment
The most common cause of acute tubular necrosis in the preterm neonate is
A. sepsis
A term neonate has hyponatremia with decreased urine sodium and reduced urine output. The most likely cause is
B. overhydration secondary to administration of electrolyte-free IV fluids
A neonate receiving IV infusion of calcium gluconate for symptomatic hypocalcemia develops bradycardia. The nurse should
C. stop the infusion immediately
A woman is breastfeeding her one week old premature neonate. She wants to use Depo-Provera as her contraceptive method and asks if this will affect her breast milk. She should be advised that Depo-Provera
B. has no adverse neonatal effect
A woman on methadone delivers a premature neonate and wants to breastfeed. She should be advised that a. breastfeeding is safe if the methadone dose is less than 50 mg/day
b. the baby should be weaned gradually to avoid withdrawal
c. transfer of methadone via breast milk precludes breastfeeding
b. the baby should be weaned gradually to avoid withdrawal
Markers of impaired fatty acid oxidation in neonates include
A. hypoglycemia
When developing a plan for a preterm neonate to transition to oral feedings, the nurse should consider that
B. coordination of suck-swallow reflex and breathing is developed by 32 weeks post-conceptual age
A mother of a preterm neonate plans to breastfeed. The father is bringing the stored frozen breast milk to the NICU each day. When unfreezing the milk, the best method is to
C. use a room temperature bath to thaw the milk
Medium chain triglycerides are added to preterm formula because they
B. do no require bile salts for absorption
When evaluating nutritional requirements for the extremely low birth weight infant, the nurse should recognize that
C. the gut is incapable of successful digestion and absorption at birth
When caring for an infant on total parenteral nutrition, the nurse should recognize that
B. cholestasis may occur as a result of excessive protein intake
The primary goal of high-freguency ventilation is to
A. reduce barotrauma by application early in the course of therapy
An infant is placed on 30% oxygen by oxyhood 4 hours post-delivery for respiratory distress. An order is obtained for a pulse oximeter. The nurse should recognize that
C. the pulse oximeter gives a continuous measurement of hemoglobin oxygen saturation
A 30-week gestational age neonate is intubated, but air entry is diminished rather than improved as expected. This should lead the nurse to consider that the tube is
B. too high
A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and a capillary blood gas reveals the following
pH 7.30, PCO2 50 mm Hg, P02 53 mm Hg, HCO3 24 mEq/L. This blood gas represents
C. respiratory acidosis
A preterm neonate had a prolonged resuscitation at birth. The infant is still experienceing respiratory distress and a capillary blood gas reveals the following
pH 7.30; PC02 50 mm Hg, PO2 53 mm Hg, HC03 24 mEq/L
When interpreting this arterial blood gas, it should be recognized that
B. the primary problem is respiratory
A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and a capillary blood gas reveals the following;
pH 7.30, PCO2 50 mm Hg, P02 53 mm Hg, HC03 24 mEq/L
The acid base derangement of respiratory alkalosis represents the presence of
a. decreased ventilation-perfusion ratio b. increased alveolar ventilation
c. increased loss of H+ ions
b. increased alveolar ventilation
An arterial blood gas of a term neonate is taken following abdominal surgery two weeks ago. The neonate is on total parenteral nutrition. pH 7.51, PC02 44 mm Hg, P02 51 mm Hg HC03 36 mEq/L. When interpreting this blood gas, it should be recognized that
A. the primary problem is metabolic
A term neonate who was resuscitated for meconium aspiration at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals
pH 7.23, PC02 49 mm Hg, P02 36 mm Hg, HC03 19 mEq/L
This blood gas represents
C. mixed acidosis
A term neonate who was resuscitated for meconium aspiration at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals
pH 7.23, PC02 49 mm Hg, P02 36 mm Hg, HC03 19 mEqL
Initial management of this neonate should include providing supplemental oxygen and
C. increasing peak inspiratory pressure
When placing a neonate on an oxygen saturation monitor, the nurse should recognize that a primary factor in obtaining an accurate reading is
C. perfusion status of the infant
While caring for an infant born at 38 weeks gestational age who was admitted to NICU to rule out sepsis, the nurse should recognize which of the following physiologic differences between a neonate and adult?
C. The shivering threshold is lower in the neonate
Intrauterine growth restricted infants are at risk for decreased glycogen stores because of
A. diminished transfer of glycogen precursors across the placenta
A neutral thermal environment is the environmental temperature in which body temperature is maintained and
B. oxygen consumption is minimized
The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to
A. limited subcutaneous tissue and brown fat stores
Interventions to decrease convective heat loss in the delivery room include
B. using transparent plastic covering over the infant
Criteria for successful weaning from an incubator to an open crib include that the infant
A. is free of major medical conditions
When an IM injection is necessary for a neonate, the anterior thigh is the site of choice. For an infant weighing <1500 gm, the volume injected into each thigh should not exceed
C. 0.5
The distribution of drugs among organs, fluids, and tissues within the body is dependent on
A. membrane permeability
A premature neonate at one week of age is experiencing apneic episodes about 6-8 times a day. A serum trough level of theophylline drawn this morning is 6.5 pg/mL
This neonate will require
A. increased dose of theophylline
When comparing theophylline and caffeine for treatment of prematurity, the nurse should know that
B. metabolism of both drugs takes place in the liver
When comparing chloral hydrate, midazolam and diazepam for use as a sedative, the nurse should recognize that
A. diazepam increases the risk of kernicterus
When caring for a neonate who is receiving methylxanthines
A. act primarily on brainstem respiratory function
A neonate is receiving hydrochlorothiazide PO every 12 hours. The nurse should understand that the pharmacologic response is
C. dependent on the existing level of renal function
The length of a drug's half-life is influenced by
A. volume of distribution
A neonate is easily overstimulated and cannot tolerate most handling. In planning care for this infant, the nurse should
A. provide containment for the infant during procedures
Kangaroo care is initated for a 34 week gestational age infant. The nurse can anticipate that such care can
A. improve physiologic self-regulation
A neonate who has been in the NICU for two weeks is demonstrating habituation in response to environmental stimuli. Habituation is best defined as
A. decreasing responsivity to external stimulus
A 35 week gestational age neonate with respiratory distress syndrome can suck and swallow a small amount of milk but then loses the swallow rhythm. Respiratory difficulty follows, and the neonate stops feeding. This is most likely due to
B. underdeveloped self-regulation behaviors
A mother asks why blanket rolls are placed around her premature infant. The nurse should advise that this is done to
B. conserve the infant
The pattern of care provided to a neonate should be based on
A. the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it
The nurse should recognize that the auditory sounds of the NICU can compromise a neonate's neurobehavioral development and that most noise is produced by
C. staff
A mother has overheard a discussion that her preterm neonate is to have a Brazelton assessment. She asks what this examination entails. The nurse's best response is that Brazelton assessment assists in
C. evaluating the interactive behavior of the newborn
A preterm neonate who has been in the neonatal intensive care unit for several months has just been weaned from a ventilator. The parents live several hundred miles away and have not been able to visit the unit on a regular basis. The mother picks up the infant, and the infant starts squirming and recoils from the mother's touch. The nurse should counsel the mother that these behaviors reflect
C. the infant's association of touch with pain
A one week old neonate born at 33 weeks gestation often engages in foot or leg bracing when stimulated. These behaviors are most consistent with
C. self-regulating behaviors
Strategies for preventing diaper dermatitis include
A. maintaining acidic skin pH
When a skin excoriation occurs, the nurse should first
A. identify the cause of the injury
To minimize skin trauma in the preterm neonate when removing adhesive tape, the nurse should use
C. pectin barriers
Most research studies regarding the use of soaps, lubricants and antimicrobial skin solutions in premature infants conclude
B. soaps including mild ones are potential irritants
A neonate born at 41 weeks gestation remains cyanotic despite oxygen administration. A soft systolic murmur can be heard on auscultation. The infant is tachypneic without respiratory distress. A chest x-ray reveals a normal size heart with decreased pulmonary vascularity. These findings are consistent with
C. pulmonary atresia
The potent stimulant of smooth muscle contraction that is essential for ductus arteriosus closure is increased
C. oxygen tension
A two day old neonate presents wih signs of congestive heart failuare, including a hyperdynamic precordium and hepatomegaly. Other significant findings include a cranial bruit and systolic ejection murmur. These physical findings are consistent with
C. arteriovenous malformation
Ventricular septal defect should additionally be suspected in the neonate with transposition of the great arteries if
B. pronounced murmur is heard
Cardiovascular function is modulated by feedback to the autonomic nervous system from baroreceptors and chemoreceptors in the
B. aorta and carotid sinus
The best fetal screening procedure for a family with a history of cogenital heart disease is a/an
C. four chamber ultrasound
Most neonates with a small ventricular septal defect present with
A. minimal left-to-right shunting
For the neonate with patent ductus arteriosus the left-to-right shunt is dependent on a decrease in
B. pulmonary vascular resistance
The first clinical sign that appears in the neonate with congenital heart disease that reflects development of pulmonary edema is
A. tachypnea
The effectiveness of nitric oxide as a treatment for pulmonary hypertension is dependent on
B. recruitment of adequate lung volume
General guidelines for surfactant replacement therapy include which of the following?
C. Administration of surfactant by bolus injection is superior to slow injection
The diagnostic tool most helpful in differentiating pneumonia from other neonatal respiratory problems is
B. chest x-ray
A neonate with microcephaly, short stature and absent thumbs develops thrombocytopenia and elevated MCV at 1 month of age. Which of the following hematologic disorders is suspected?
B. Fanconi anemia
Patients with respiratoy distress syndrome exhibit a rapid and shallow breathing pattern. This is due to the work required to
A. overcome the negative intrapleural pressure generated by contraction of the diaphragm and the respiratory muscles
Following treatment of respiratory distress syndrome in premature infants with surfactant therapy, the anticipated improvement in oxygenation can be attributed to
A. enhanced matching of ventilation and perfusion
A newborn with respiratory distress has a chest x-ray that reveals unilateral or bilateral streaky densities and confluent mottled, opacified areas. The nurse should anticipate that initial intervention should be
C. culture of endotracheal tube aspirate
The diffuse opacification seen on the chest x-ray of a neonate with respiratory distress syndrome primarily reflects
B. pulmonary edema
Intervention directed at reducing the risk of pneumothorax for a premature infant with respiratory distress syndrome includes
B. positioning and securing the endotracheal tube
Research studies regarding the use of chest physiotherapy have found that
C. more study is needed to determine its benefits and disadvantages
The most useful way to differentiate between respiratory and non-respiratory disease in the neonate is
B. chest x-ray
A shunt study is performed on a neonate with respiratory distress, and the Pa02 does not change after 100% oxygen was administered. Based on this finding, it can be assumed that
A. right-to-left shunting is present
A neonate has respiratory distress without cyanosis. The nurse should recognize that
B. cardiac lesions with poor systemic output cause respiratory distress
Transient tachypnea of the newborn is defined as what type of lung disease
C. obstructive
After placement of a chest tube 24 hours ago, the nurse notes fluctuation of the fluid in the tube. The nurse should recognize that
A. this indicates the tube is patent and functional
A factor that differentiates the pathophysiology between meconium ileus and meconium plug syndrome is the presence of
B. enzymatic deficiency
A characteristic that is present in both omphalocele and gastroschisis is
B. malrotation of the intestine
Absence of the ileocecal valve in the neonate with short bowel syndrome can lead to
B. overgrowth of bacteria in the small intestine
Hirschsprung's disease occurs due to
C. ganglion cell deficiency
The x-ray of a neonate with suspected necrotizing enterocolitis shows pneumoperitoneum. This finding is consistent wih
C. bowel perforation
A 3 day old neonate has hematuria, decreased urine output and platelet count of 60,000. Which of the following is the most likely diagnosis?
C. renal vein thrombosis
A 32 week gestational age male neonate has a 4 cm nontender mass in the right groin. The initial step for differential diagnosis is
C. palpation
The most important factor in the pathogenesis of neonatal renal vein thrombosis is
C. birth asphyxia
The pathogensis of congenital adrenal hyperplasia includes
C. conversion of progesterone to cortisol and aldosterone is prevented
Hypochloremia may occur secondary to diminished intake or increased loss of chloride. clinical manifestations include
A. metabolic alkalosis
When a parent is to donate blood to their neonate for a blood transufusion, it is imperative that
C. parental blood components be irradiated before use
A neonate born at 31 weeks gestation has coagulation studies performed and the following results are obtained: PTT: moderately prolonged; PT: severly prolonged; TT: mildly moderately prolonged; FIB: Decreased; D-Dimer: Positive; Platelets: Decreased. These findings are consistent with
A. liver disease
A neonate a few hours after birth develops patchy areas of skin thrombosis over the chest and buttocks. The painful lesions are palpable and dark red, changing to purple and black. This neonate requires administration of fresh frozen plasma and
B. replacement of proteins C or S
The primary therapy for disseminated intravascular coagulation consists of
C. treatment of the underlying disorder
Anemia of prematurity is characterized by a low reticulocyte count and
B. inadequate response to erythropoietin
A three day old neonate with heart failure and pulmonary edema shows bloody frothy fluid from the trachea. This is consistent with
B. pulmonary hemorrhage
Initial management of a four day old breastfed infant with hyperbilirubinemia would include
C. increasing breastfeeding to 12 feedings per day
The efficacy of phototherapy depends on
B. irradiance in the blue spectrum of the lights
Which of the following is a true statement regarding neonatal hyperbilirubinemia
C. newly synthesized unconjugated bilirubin is fat soluble
A cranial suture line of a neonate reveals an immovable bony prominence which is even and smooth bilaterally. This neonate should be evaluated for
C. increased intracranial pressure
An increase in cerebral blood flow can be expected in association with
A. decreased Pa02
The neuropathologic consequences of the germinal matrix and intraventricular hemorrhage include
A. infarction of periventricular white matter
Hemorrhagic disease of the newborn is attributed to a deficiency of vitamin K-dependent factors. Additional predisposing characteristics include
C. breastfeeding
A preterm infant of a diabetic mother has experienced several seizures. The most important action that needs to be taken with this neonate is to
B. identify underlying cause of the seizures
A neonate post-surgery for necrotizing enterocolitis 48 hours ago is on a ventilator. The neonate is grimacing and eyes are tightly shut. The heart rate is increased and the neonate is breathing over the ventilator. The most appropriate intervention would be to obtain an order for
B. pain medication
Macrocephaly commonly occurs with which of the following disorders of brain formation
C. Dandy-Walker syndrome
Thymus-derived (T) cells are important in
B. delayed hypersensitivity reactions
A female neonate was delivered at 28 weeks gestation. The amniotic fluid was meconium stained. Physicial examination shows a papular erthematous skin rash and enlarged liver. Tone is poor and the infant has had several episodes of apnea. Infection is suspected. The organism most likely responsible for this neonate's symptoms is
B. listerial monocytogenes
A woman adequately treated for syphilis during pregnancy delivers an asymptomatic infant. Appropriate managment of the neonate should include
C. serologic evaluation 1, 2, 3, 6 and 12 months of age
Perinatal transmission of HIV infection is increased when the mother has
C. low CD4 + lymphocyte count
Assessment of a term neonate is as follows: IUGR, microcephaly, congenital cataracts, hepatosplenomegaly, jaundice. Based on these findings, the most likely diagnosis is congenital
C. cytomegalovirus
A six day old neonate develops eyelid swelling with a purulent discharge. Gram negative intracellular diplococci are identified on gram stain. This conjunctivitis is caused by
B. gonorrhea
In comparing neonates with early and late onset of Group B streptococcal infection, the nurse should recognize that
B. meningitis is the most common complication in both groups of infants
A neonate born to a mother treated for premature labor with magnesium sulfate has a magnesium level of 4.8 mg/dL. This neonate should be managed wih
A. supportive care
A neonate has a low T4 and elevated TSH on two consecutive newborn screening tests. The appropriate next step would be
C. immediate thyroid hormone replacement therapy
An increased incidence of low serum calcium levels occurs in neonates who
A. have a history of asphyxia
A clinical indicator of the neonatal response to pain or stress is
A. release of growth hormone
An umbilical artery catheter was inserted in the delivary room during resuscitation of a 34 week gestation female neonate. In caring for this infant, the nurse should recognize
B. low placement of the UAC decreases the risk of vascular accident
Infants of diabetic mothers are at increased risk for hypoglycemia because of persistent insulin action and
a. a lack of circulating glucagon levels
b. abnormalities in glucose metabolism c. peripheral glucose uptake
c. peripheral glucose uptake
A predisposing factor to osteopenia of prematurity is
C. prolonged parental nutrition
A two week old full term infant who has been hospitalized since birth due to surgery for intestinal obstruction presents with scaly skin and areas of desquamation. There are areas of irritation and oozing in the neck, groin, and perianal region. These symptoms are most likely caused by
B. essential fatty acid deficiency
Which of the following is a characteristic of an autosomal recessive disorder
B. parents are phenotypically normal
A characteristic that is common to trisomy 13, trisomy 18 and trisomy 21 is that these neonates commonly have
C. hand or finger abnormalities
Characteristics of bilateral multicystic dysplastic kidneys include
B. obstruction at the ureteropelvic junction
The scanning modality of choice to evaluate the anatomy of the obstructing tissue in choanal atresia is
C. computerized tomography
Nasal septum dislocation can be differentiated from normal variant of a misshappened nose by performing
C. a compression test
On examination of the newborn head, the nurse palpates the margin of parietal and occipital regions along the lamboidal suture and feels a ping-pong effect over the area. This finding is indicative of
B. carniotabes
A term neonate who was born to an HBsAg positive mother is being discharged two months after birth following surgery for a cardiac condition. The mother asks when the next hepatitis B immunization should be given. The nurse should advise that it should be given
A. at the same time the measles-mumps-rubella vaccinations are given
Concerning administration of immunizations to hospitalized preterm infants, the nurse should be aware that
A. measles-mumps-rubella vaccine should not be given
The timing of discharge of a preterm neonate born at 31 weeks gestation is based on
C. physiologic stability and family resources for care
The parents of a four year old daughter must tell her that her newborn baby sister has died. Considering the cognitive understanding child, they should
C. provide opportunites for repetitive explanations
Symptoms of grief and depression are very similar following neonatal loss. Specific symptoms that suggest referral to a mental health professional is indicated include
B. guilt unrelated to the infant
A mother is given her premature sick neonate to hold for the first time. She gently holds the infant using primarily finger touching interaction. The nurse should recognize that
B. this mother needs time to gain confidence that her touching is not hurting the infant
When giving medical information to parents of a premature sick infant, information should be presented
A. directly and honestly but using an individualized balanced approach
In research, an instrument that is able to otain consistent results is termed
B. reliable
A theory that purports that moral rightness of an act must be made totally separate from the consequence of the action is called
