NNP Practice Exam (CCPR 2017) 174 Questions with Verified Answers
A 32 week gestation infant with decreased renal function develops systemic
... [Show More] candidiasis. The best choice of antifungal therapy for this baby is
a. amphotericin B lipid complex
b. fluconazole
c. flucytosine - CORRECT ANSWER a. amphotericin B lipid complex
Increased bowel sounds are indicative of
a. Ileus
b. Malrotation
c. Starvation - CORRECT ANSWER b. Malrotation
Infants with Beckwith-Wiedemann syndrome have a high risk for which anomaly?
a. Microglossia
b. Omphalocele
c. Volvulus - CORRECT ANSWER b. Omphalocele
A term neonate is found to have ambiguous genitalia. The anticipated immediate action would include obtaining
a. blood electrolytes
b. intravenous pyelogram
c. pelvic ultrasound - CORRECT ANSWER a. blood electrolytes
4. Plethora can be seen in infants who are
a. overfed
b. overheated
c. stimulated - CORRECT ANSWER b. overheated
5. 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 - CORRECT ANSWER c. placental transfer of antibodies to the fetus
In a 26 week gestational age neonate, the expected physical findings would include a
a. barely apparent Moro reflex
b. no resistance to heel to ear maneuver
c. weak finger grasp - CORRECT ANSWER b. no resistance to heel to ear maneuver
A female neonate was delivered at 28 weeks gestation. The amniotic fluid was meconium stained. Physical examination shows a erythematores rash with small, pale papules. 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
a. Escherichia coli
b. Group B streptococcus
c. Listeria monocytogenes - CORRECT ANSWER c. Listeria monocytogenes
A neonate is receiving a calcium infusion for treatment of hypocalcemia. The nurse should
a. monitor for oxygen saturation changes
b. obtain an EKG before and after the infusion
c. place the infant on a cardiac monitor - CORRECT ANSWER c. place the infant on a cardiac monitor
Patients with respiratory distress syndrome exhibit prominent retractions with respiratory effort. This is due to the work required to
a. generate high intrathoracic pressures
b. overcome the negative intrapleural pressure generated by contraction of the diaphragm and the respiratory muscles
c. trap alveolar air and maintain functional residual capacity - CORRECT ANSWER a. generate high intrathoracic pressures
Assessment of a term neonate is as follows: IUGR, microcephaly, congenital cataracts, hepatosplenomegaly, and jaundice. Based on these findings, the most likely diagnosis is congenital
a. cytomegalovirus
b. rubella
c. toxoplasmosis - CORRECT ANSWER b. rubella
Infants born to mothers with myasthenia gravis
a. are at risk for aspiration
b. will present with symptoms within first 12 hours of life.
c. transient myasthenia gravis will resolve spontaneously around 6 months of age. - CORRECT ANSWER a. are at risk for aspiration
Based on the intrauterine growth chart shown, this neonate would be classified as (38wks, 25th percentile)
a. post-term, SGA
b. term, AGA
c. term, SGA - CORRECT ANSWER b. term, AGA
Continued posturing of a limb is characteristic of
a. clonic seizures
b. myoclonic seizures
c. tonic seizures - CORRECT ANSWER c. tonic seizures
A disadvantage of continuous renal replacement therapy with hemofiltration in the treatment of acute renal failure is that
a. constant heparinization during therapy is required
b. it causes rapid solute and fluid shifts
c. the patient must be hemodynamically stable prior to therapy - CORRECT ANSWER a. constant heparinization during therapy is required
The hallmark finding of pneumatosis intestinalis is
a. air within the wall of the intestine
b. local bowel edema
c. perforation of the bowel wall - CORRECT ANSWER a. air within the wall of the intestine
A neonate is born to a mother with a positive tuberculin 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 - CORRECT ANSWER b. no special evaluation or therapy
An unexpected occurrence involving death or serious physical or psychological injury is called
a. a sentinel event
b. an incident
c. malpractice - CORRECT ANSWER a. a sentinel event
Bullous lesions appear on an infant's skin on day 2 of life. The nurse should recognize that this finding is
a. benign
b. due to an irritant
c. indicative of infection - CORRECT ANSWER c. indicative of infection
A neonate is apneic at birth and positive-pressure ventilation with 21% oxygen is initiated. After 30 seconds the neonate's heart rate is 50. What is the next step in resuscitation of this neonate?
a. Administer epinephrine 0.1-0.3 ml/kg
b. Begin chest compressions
c. Increase oxygen to 50% - CORRECT ANSWER b. Begin chest compressions
When developing a plan for a preterm neonate to transition to oral feedings, the nurse should consider that
a. breast feeding requires more energy than bottle feeding in all infants
b. coordination of suck-swallow reflex and breathing is developed by 34 weeks postconceptual age
c. vigorous non-nutritive sucking is a predictor for oral feeding readiness - CORRECT ANSWER b. coordination of suck-swallow reflex and breathing is developed by 34 weeks postconceptual age
Ideally antiretroviral prophylaxis is initated and administered in the HIV exposed neonate within
a. 12 hours of birth
b. 24 hours of birth
c. 48 hours of birth - CORRECT ANSWER a. 12 hours of birth
A 5 day old infant develops a very watery eye discharge that progressed rapidly to purulent exudate. Chlamydia trachomatis conjunctivitis is diagnosed. The nurse should be aware that
a. gentle pressure over nasolacrimial sac results in mucopurulent drainage
b. this patient is at risk for corneal ulceration, perforation and visual impairment
c. therapy of choice is oral erythromycin x 14 days - CORRECT ANSWER c. therapy of choice is oral erythromycin x 14 days
Concerning administration of immunizations to hospitalized preterm infants, the nurse should be aware that
a. administration of dexamethasone may decrease immune response
b. doses are lower than doses for term infants
c. measles-mumps-rubella vaccine should not be given - CORRECT ANSWER c. measles-mumps-rubella vaccine should not be given
When developing a plan for a preterm neonate to transition to oral feedings, the nurse should consider that
a. breast feeding requires more energy than bottle feeding in all infants
b. coordination of suck-swallow reflex and breathing is developed by 34 weeks postconceptual age
c. vigorous non-nutritive sucking is a predictor for oral feeding readiness - CORRECT ANSWER b. coordination of suck-swallow reflex and breathing is developed by 34 weeks postconceptual age
Because neonates have a limited ability to excrete concentrated urine, there is an increased risk for
a. dehydration
b. fluid overload
c. infection - CORRECT ANSWER a. dehydration
The 3000 gm neonate born at 36 weeks is at increased risk for
a. ABO Incompatability
b. hyperbilirubinemia
c. no major significant problems - CORRECT ANSWER b. hyperbilirubinemia
Twin to twin transfusion occurs in multiple gestations when which factor is involved?
a. Delayed cord clamping
b. Dizygotic twins
c. Unequal placental sharing - CORRECT ANSWER c. Unequal placental sharing
A term, small for gestational age neonate at four hours of age is tachypneic, plethoric, lethargic and has a blood sugar of 53 mg/dL and a central hematocrit of 70%. The most likely diagnosis is
a. hyperviscosity
b. hypocalcemia
c. hypoglycemia - CORRECT ANSWER a. hyperviscosity
The mother of a newborn daughter with spina bifida states that she feels helpless as her four year old son has started wetting the bed and asks what she can do to change his behavior. The best response would be to
a. enroll the son in half-day preschool to promote interaction with other children
b. explain that her son may feel that he is the cause of his sister's condition
c. explain this behavior is normal, and it gets better on its own - CORRECT ANSWER b. explain that her son may feel that he is the cause of his sister's condition
A newborn exhibits respiratory distress in the delivery room that resolves with crying. What is the likely diagnosis?
a. Choanal atresia
b. Robin anomaly
c. Laryngeal web - CORRECT ANSWER a. Choanal atresia
After establishing what appeared to be effective ventilation in a resuscitation the heart rate remains below 60. The next step to consider is
a. administering IV epinephrine
b. beginning chest compressions at 1/4 diameter of chest
c. initiating intubation - CORRECT ANSWER c. initiating intubation
A benefit of habituation is
a. hand to mouth coordination
b. language development
c. protection from overstimulation - CORRECT ANSWER c. protection from overstimulation
A father's reaction to stress
a. is no different than the mother's reaction
b. is just as important as the mother's reaction
c. often manifests as anger - CORRECT ANSWER b. is just as important as the mother's reaction
The determination that the standard of care has been met is based on what similarity of a prudent and reasonable nurse?
a. Actions taken in the same situation
b. Comparative workplace and conditions
c. Equivalent education - CORRECT ANSWER a. Actions taken in the same situation
Congenital varicella syndrome is characterized by:
a. cataracts
b. early death
c. microcephaly - CORRECT ANSWER b. early death
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 temperature: 36.6°C (97.8°F); Heart rate: 176 b/p/m; Respiratory rate: 84 breaths per minute; Capillary refill: 5 seconds; Urine output: 0.2 mL/kg/hour. A diagnostic step that is useful is
a. assessing for the presence of diastolic murmur
b. drawing serial blood gases in room air and 100% oxygen
c. obtaining blood pressures in all four extremities - CORRECT ANSWER c. obtaining blood pressures in all four extremities
An umbilical artery catheter was inserted in the delivery room during resuscitation of a 34 week gestation female neonate. In caring for this infant, the nurse should recognize
a. addition of heparin to the infusate decreases the risk of aortic thrombus
b. heparin use in flush solution will help decrease risk of catheter occlusions
c. low placement of the UAC decreases the risk of vascular accident - CORRECT ANSWER b. heparin use in flush solution will help decrease risk of catheter occlusions
In teaching parents how to interact with their infant, they should be taught that
a. vision is more important for attachment than hearing.
b. talking gently to their infant while providing care is encouraged.
c. repetitive sounds usually result in overstimulation. - CORRECT ANSWER b. talking gently to their infant while providing care is encouraged.
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
c. Increased systemic pressure - CORRECT ANSWER b. Elimination of right-to-left shunting
The en face position takes place in what phase of initial attachment?
a. acquaintance
b. engrossment
c. reciprocity - CORRECT ANSWER a. acquaintance
A characteristic that is common to trisomy 13, trisomy 18 and trisomy 21 is that these neonates commonly have
a. eye abnormalities
b. hand or finger abnormalities
c. renal malformation - CORRECT ANSWER b. hand or finger abnormalities
Despite good oxygenation an infant has weak peripheral pulses, persistent tachycardia and diminished muscle tone. The most appropriate intervention would be
a. epinephrine 0.1 - 0.3 ml/kg
b. normal saline 10 ml/kg
c. sodium bicarbonate 2 mEq/kg - CORRECT ANSWER b. normal saline 10 ml/kg
The likely cause of hypomagnesmia in an asymptomatic twelve-hour old neonate is
a. inmature renal fuction
b. maternal insulin-dependent diabetes
c. placental insufficiency - CORRECT ANSWER c. placental insufficiency
The most useful diagnostic tool to differentiate between respiratory and nonrespiratory disease in the neonate is
a. arterial blood gas
b. chest x-ray
c. shunt study - CORRECT ANSWER c. shunt study
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
a. a disorganized response
b. pain responses
c. self-regulating behaviors - CORRECT ANSWER c. self-regulating behaviors
A 3 day old full term infant's unconjugated bilirubin level is 20 mg/dl. The best therapy for this infant is
a. phototherapy and administration of phenobarbital
b. phototherapy and exchange transfusion
c. phototherapy only - CORRECT ANSWER c. phototherapy only
The ability to habituate to sound is
a. a negative response to sound
b. accomplished by preterm infants more quickly than term infants
c. indicative of an intact CNS - CORRECT ANSWER c. indicative of an intact CNS
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
a. assessing neurologic integrity and behavioral factors
b. confirming gestational age based on socialization abilities
c. evaluating the interactive behavior of the newborn - CORRECT ANSWER c. evaluating the interactive behavior of the newborn
Physiologic characteristics of Ebstein's Anomaly include
a. bicuspid aortic valve
b. downward displacement of the tricuspid valve
c. severe pulmonary parenchymal disease - CORRECT ANSWER b. downward displacement of the tricuspid valve
A key principle for 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
Submit Submit Submit Submit - CORRECT ANSWER b. medications are not a substitute for adequate ventilation
A common complication of percutaneous central lines include
a. cardiac perforation
b. catheter entrapment
c. extravasation - CORRECT ANSWER c. extravasation
Transient tachypnea of the newborn is defined as what type of lung disease?
a. Inflammatory
b. Obstructive
c. Restrictive - CORRECT ANSWER b. Obstructive
Neonates with depressed skull fractures commonly
a. are at increased risk for intracranial hemorrhage
b. require follow up but complete recovery is typical
c. require surgical intervention - CORRECT ANSWER a. are at increased risk for intracranial hemorrhage
The principal action of volume expanders during resuscitation is to
a. address myocardial decompensation
b. facilitate peripheral vasoconstriction
c. maintain cardiac output and blood pressure - CORRECT ANSWER c. maintain cardiac output and blood pressure
A 2500 gm neonate is fed 20 cc of formula every 3 hours. Over the past 12 hours gastric residuals have ranged from 3-5 cc's. The most appropriate action is to
a. continue with the feedings
b. decrease the volume
c. slow the rate of feedings - CORRECT ANSWER a. continue with the feedings
A neonate is to start oral feedings. The mother had planned to breastfeed, but she now has a recurrence of herpes and has a lesion on her lower abdomen. The nurse should advise that
a. breastfeeding is contraindicated until the lesion heals
b. she should cover the lesion with a dressing while breastfeeding
c. feeding may be initiated using the mother's pumped breast milk - CORRECT ANSWER b. she should cover the lesion with a dressing while breastfeeding
On examination of the newborn head, the nurse palpates the margin of parietal and occipital regions along the lamboidal suture. The area will collapse and recoil under gentle pressure This finding is indicative of
a. craniosynostosis
b. craniotabes
c. molding - CORRECT ANSWER b. craniotabes
Compared to morphine, fentanyl citrate may produce
a. bronchospasm
b. chest wall rigidity
c. tachycardia - CORRECT ANSWER b. chest wall rigidity
Soy-based formulas are recommended for infants who have
a. Galactosemia
b. Lactose intolerance
c. Renal insufficiency - CORRECT ANSWER a. Galactosemia
During the time a very low birthweight neonate is in the delivery room, methods that can be used to prevent heat loss include
a. dry and wrap in polyethylene sheet
b. place wool cap on head
c. leave the radiant warmer on for 24 hours - CORRECT ANSWER b. place wool cap on head
A neonate can be assumed to be at an advanced gestational age if neuromuscular development demonstrates increased
a. hip flexion and adduction
b. popliteal angle
c. square window angle measurement - CORRECT ANSWER a. hip flexion and adduction
A 5 day old neonate becomes irritable, cyanotic and tachypneic. The nurse notices that when the infant cries, the cyanosis becomes more pronounced. The most likely origin of these symptoms is
a. cardiac
b. metabolic
c. pulmonary - CORRECT ANSWER a. cardiac
The diagnostic tool most helpful in differentiating pneumonia from other neonatal respiratory problems is
a. sepsis work-up
b. serial chest x-rays
c. tracheal aspirate - CORRECT ANSWER b. serial chest x-rays
A neonate has had several episodes of vomiting. The arterial blood gas results are: pH: 7.53; PCO₂: 42 mm Hg; PO₂: 56 mm Hg; Base Excess: 33 mEq/L. This blood gas represents
a. borderline normal finding
b. compensated metabolic acidosis
c. metabolic alkalosis - CORRECT ANSWER c. metabolic alkalosis
The normal 5 to 10 percent weight loss that occurs in the term newborn is primarily due to
a. fluid shifts
b. immature renal function
c. maximal energy output - CORRECT ANSWER a. fluid shifts
Which test should be obtained to distinguish swallowed maternal blood from neonatal blood
a. Apt
b. Duffy
c. Keihauer-Betke - CORRECT ANSWER a. Apt
A neonate is receiving hydrochlorothiazide PO 1 mg/kg every 12 hours. The nurse should understand that thiazide diuretics
a. commonly lead to electrolyte disturbances
b. exert their effect on the loop of heule
c. promote calcium loss - CORRECT ANSWER a. commonly lead to electrolyte disturbances
A thyroid screen of a 36 hours 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 - CORRECT ANSWER b. have confirmatory serum testing
The organism most commonly responsible for early-onset bacterial infection in the neonate is
a. Escherichia coli
b. Group B streptococci
c. Methcillin resistant staphylococcus aureus - CORRECT ANSWER b. Group B streptococci
A shunt study is performed on a neonate with respiratory distress, and the PaO2 does not change after 100% oxygen was administered. 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 - CORRECT ANSWER b. right-to-left shunting is present
Of the following, the most common environmental triggers for patent ductus arteriosis is
a. amphetamines
b. varicella zoster
c. diabetes - CORRECT ANSWER a. amphetamines
Agenesis of the corpus callosum commonly occurs with which of the following disorders of brain formation?
a. Baraitser - Winter syndrome
b. Dandy-Walker syndrome
c. Zellweger syndrome - CORRECT ANSWER b. Dandy-Walker syndrome
An asymptomatic neonate has a serum glucose level of 39 mg/dL. The neonate was fed 30ml of infant formula po. 30 minutes after the feeding the glucose level is 35 mg/dL. The next step is to
a. begin continuous infusion of D10W
b. give a IV bolus of D10W
c. recheck glucose in 30 minutes - CORRECT ANSWER b. give a IV bolus of D10W
Natal teeth are more commonly seen in the
a. African American population
b. Caucasian population
c. Native American population - CORRECT ANSWER c. Native American population
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 - CORRECT ANSWER b. 90-100 kcal/kg/day
he AAP recommends that NICU noise levels be below:
a. 45 decibel
b. 65 decibel
c. 85 decibel - CORRECT ANSWER a. 45 decibel
When a research finding is determined not likely to have occurred by the chance alone, this is termed
a. a best practice
b. evidence-based
c. statistically significant - CORRECT ANSWER c. statistically significant
Brushfield spots are associated with which of the following syndromes
a. Trisomy 13
b. Trisomy 18
c. Trisomy 21 - CORRECT ANSWER c. Trisomy 21
A neonate with critical aortic stenosis is in a radiant warmer. The heart lesion is being managed with prostaglandin E1. On admission, the neonate required a servo control temperature of 36.5°C (97.7°F) to maintain a temperature of 37°C (98.6°F). The neonate is currently requiring a servo control temperature of 34°C (94.2°F). This change can be attributed to
a. humidified environment
b. probe malfunction
c. prostaglandin E1 therapy - CORRECT ANSWER c. prostaglandin E1 therapy
The preferred method of diagnosing HIV infection in the neonate is
a. DNA PCR
b. plasma viral RNA
c. viral culture - CORRECT ANSWER a. DNA PCR
Criteria for classifying supraventricular tachycardia in the neonate include
a. decreased heart rate with activity
b. little variability in heart rate with activity
c. profound heart rate variability with activity - CORRECT ANSWER b. little variability in heart rate with activity
The difference in human milk from mothers of premature infants when compared to that of mature human milk is a lower concentration of
a. calcium
b. protein
c. lipids - CORRECT ANSWER a. calcium
Low urinary chloride can be caused by
a. diuretic therapy
b. prolonged vomiting
c. soy formula - CORRECT ANSWER b. prolonged vomiting
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 - CORRECT ANSWER b. directly and honestly but using an individualized balanced approach
A 35 week gestational age neonate 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
a. a weak suck reflex
b. tongue thrusting movements
c. underdeveloped self-regulation behaviors - CORRECT ANSWER c. underdeveloped self-regulation behaviors
Amnioinfusion during labor may minimize the morbidity caused by
a. cord compression
b. head compression
c. placenta previa - CORRECT ANSWER a. cord compression
The first sign of hypothermia in a critically ill neonate is a drop in which temperature?
a. Axillary
b. Rectal
c. Skin - CORRECT ANSWER c. Skin
A clinical indicator of the neonatal response to pain or stress is
a. decrease in PCO₂
b. lower cortisol levels
c. release of growth hormone - CORRECT ANSWER c. release of growth hormone
When considering the administration of central nervous system medications for neonates, the nurse should consider that the medication
a. dose will decrease as the infant's proportion of body fat increases
b. may have a shortened half-life due to altered metabolism
c. must be lipid soluble to cross the blood brain barrier - CORRECT ANSWER c. must be lipid soluble to cross the blood brain barrier
Neonates with linear skull fractures commonly
a. are at increased risk for intracranial hemorrhage
b. require follow up but complete recovery is typical
c. require surgical intervention - CORRECT ANSWER b. require follow up but complete recovery is typical
Prenatal nuchal translucency is a screening test for
a. aneuploidy
b. cystic fibrosis
c. gastroschisis - CORRECT ANSWER a. aneuploidy
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 - CORRECT ANSWER b. a hemoglobin level of 18 g/dL
The correct tidal volume for newborn resuscitation is
a. 5 ml/kg
b. 10 ml/kg
c. 15 ml/kg - CORRECT ANSWER a. 5 ml/kg
A 32 week infant with severe IUGR is experiencing seizures, which study should be ordered immediately for quickest results?
a. Hair analysis
b. Meconium analysis
c. Urine toxicology screen - CORRECT ANSWER c. Urine toxicology screen
The recommendation regarding the 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 - CORRECT ANSWER c. avoid administration
Elemental formulas are indicated for infants
a. born prematurely
b. with lactose intolerance
c. with malabsorption - CORRECT ANSWER c. with malabsorption
Kangaroo care is initiated for a 34 week gestational age infant. The nurse can anticipate that such care can
a. improve physiologic self-regulation
b. increase the risk of apneic episodes
c. precipitate temperature instability - CORRECT ANSWER a. improve physiologic self-regulation
An advantage of a skin servo-controlled incubator is
a. less air temperature variation
b. more effective neutral thermal environment
c. more stable thermal environment - CORRECT ANSWER b. more effective neutral thermal environment
On physical examination of the newborn's abdomen, a normal finding is when the
a. bladder can be palpated up to 1 cm below the pubis symphysis when urine is present
b. liver edge is palpated up to 2.5 cm below the right costal margin
c. tip of the spleen is palpated 1 cm below the left costal margin - CORRECT ANSWER b. liver edge is palpated up to 2.5 cm below the right costal margin
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 - CORRECT ANSWER c. insufficient intake of calcium and phosphorus
An x-ray of a neonate with worsening cyanosis, tachypnea and respiratory distress shows the following: air trapping, hyperexpansion, hyperinflation, bilateral coarse patchy infiltrates. These findings are most consistent with
a. meconium aspiration syndrome
b. persistent pulmonary hypertension
c. respiratory distress syndrome - CORRECT ANSWER a. meconium aspiration syndrome
In performing a gestational age examination, the infant's hand is flexed on the forearm between the thumb and index finger of the examiner. This maneuver demonstrates
a. arm recoil
b. scarf sign
c. square window - CORRECT ANSWER c. square window
The finding of a third fontanelle along the sagittal suture suggests
a. arteriovenous malformation
b. congenital anomaly
c. increased intracranial pressure - CORRECT ANSWER b. congenital anomaly
Glucose use by the brain is greater in infants who are
a. asymmetrically growth restricted
b. jaundiced
c. post-term - CORRECT ANSWER a. asymmetrically growth restricted
A giant nevus is the most concerning of the congenital pigmented nevi because it
a. is at risk of malignant transformation
b. is often asociated with hearing loss
c. confirms diagnosis of McCune-Albright Syndrome - CORRECT ANSWER a. is at risk of malignant transformation
The following should be considered when immunizations in infants less than 2.5 kg:
a. divided doses
b. number of injection sites available
c. volume of vaccine - CORRECT ANSWER b. number of injection sites available
An increase in pulmonary blood flow in a neonate with patent ductus arteriosus results in
a. a decrease in pulmonary vascular resistance
b. right to left shunting
c. volume overload of the left ventricle - CORRECT ANSWER c. volume overload of the left ventricle
In comparison to mature breast milk, the relative content of premature breast milk has
a. decreased caloric content
b. decreased fat content
c. increased protein content - CORRECT ANSWER c. increased protein content
The Nurse Licensure Compact refers to the ability to
a. hold multiple state nursing licenses
b. independently prescribe drugs
c. practice nursing across state lines - CORRECT ANSWER c. practice nursing across state lines
A neutral thermal environment helps support basic physiologic function and growth in the neonate by
a. conserving metabolic activity
b. increasing caloric expenditure
c. maximizing oxygen consumption - CORRECT ANSWER a. conserving metabolic activity
Which of the following statements is true for a mother following the loss of one infant of a multiple birth?
a. The loss of the baby will be diminished because the mother has a living infant
b. The process of grief is intensified for the parent
c. There is usually less support for grieving parents because the frequent response is that they should be thankful for the survival of the living child - CORRECT ANSWER c. There is usually less support for grieving parents because the frequent response is that they should be thankful for the survival of the living child
The most common cause of acute tubular necrosis in the full term infant is
a. perinatal asphyxia
b. renal vein thrombosis
c. sepsis - CORRECT ANSWER a. perinatal asphyxia
When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is
a. a cuffed endotracheal 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 - CORRECT ANSWER c. insertion of an endotracheal tube should be done as quickly as possible
A phenotypic feature of Trisomy 18 is
a. clinodactyly
b. hypotonia
c. macrocephaly - CORRECT ANSWER a. clinodactyly
A supportive intervention for the parents of a dying infant is to
a. leave the family alone
b. offer to stay with the family until asked to leave
c. stay with the family - CORRECT ANSWER b. offer to stay with the family until asked to leave
Preauricular ear tags are
a. associated with brachial arch abnormalities
b. confirmatory of renal anomalies
c. diagnostic for chromosomal diseases - CORRECT ANSWER a. associated with brachial arch abnormalities
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 - CORRECT ANSWER a. provide containment for the infant during procedures
A neonate is born with a cavernous hemangioma. The parents are concerned about the cosmetic effect of this skin disorder. The nurse should advise that
a. hemangioma will reduce in size by 6 months of age
b. involution will occur around 1 year of age
c. surgical excision for cosmetic appearance is common - CORRECT ANSWER
A three day old neonate with heart failure and pulmonary edema shows bloody frothy fluid from the trachea. This is consistent with
a. pleural effusions
b. pulmonary hemorrhage
c. pulmonary interstitial emphysema
Submit Submit Submit Submit - CORRECT ANSWER b. pulmonary hemorrhage
On auscultation of the lungs, a high-pitched sound is heard during expiration. This is consistent with
a. rhonchi
b. stridor
c. wheezes - CORRECT ANSWER c. wheezes
Decreasing the amplitude on high frequency oscillators results in
a. decreased PO₂
b. increased PCO₂
c. increased tidal volume - CORRECT ANSWER b. increased PCO₂
The correct position for cardiac compressions during neonatal resuscitation is shown at point
a. A
b. B
c. C - CORRECT ANSWER c. C
Neonatal Bartter Syndrome is an inherited disorder characterized by
a. electrolyte imbalance and dehydration
b. hypotonia, lethargy and poor feeding
c. hypoglycemia and macrosomia - CORRECT ANSWER a. electrolyte imbalance and dehydration
The effectiveness of nitric oxide as a treatment for pulmonary hypertension is dependent on
a. pulmonary ventilation-perfusion ratio
b. recruitment of adequate lung volume
c. the extent of right-to-left shunting - CORRECT ANSWER b. recruitment of adequate lung volume
A neonate has a flat pink lesion on the nose. The lesion has diffuse borders, blanch with pressure and become pinker with crying. The nurse should suspect
a. hemangioma
b. nevus simplex
c. port wine stain - CORRECT ANSWER b. nevus simplex
The mother of a 29 week gestational age neonate is gently stroking her infant. The infant starts to breathe irregularly and extends extremities. The nurse should
a. advise the mother to stop stroking the infant and to talk in a low voice instead
b. assist the mother with putting the infant back in the incubator
c. assist the mother in providing supportive containment - CORRECT ANSWER c. assist the mother in providing supportive containment
Most research studies regarding the use of soaps, lubricants and antimicrobial skin solutions in premature infants conclude
a. cleansers with alkaline pH and minimal dyes and perfumes are good choices
b. povidone-iodine is a safe agent for surgical skin preparation
c. use of emollient creams may be of benefit - CORRECT ANSWER c. use of emollient creams may be of benefit
The most common reason for development of sore nipples in the breastfeeding woman is
a. improper infant position
b. neonatal tongue movements
c. strength of sucking - CORRECT ANSWER a. improper infant position
After delivery, a term neonate begins gagging on secretions and has episodes of vomiting. An orogastric tube is passed and 30 mL of gastric aspirate is obtained. The maternal history is likely to reveal a history of
a. polyhydramnios
b. sickle cell anemia
c. systemic lupus erythematosus - CORRECT ANSWER a. polyhydramnios
A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and a arterial blood gas reveals the following: pH 7.30: PCO₂: 50 mm Hg: PO₂: 60 mm Hg: HCO₃: 24 mEq/L. 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 - CORRECT ANSWER b. the primary problem is respiratory
A neonate with a moderate subarachnoid hemorrhage is being discharged. The parents are concerned about the infant's potential problems. The nurse should advise that
a. cerebral palsy is a rare occurrence
b. hydrocephalus is the most common problem
c. learning and attentive disabilities are common - CORRECT ANSWER b. hydrocephalus is the most common problem
Respiratory compensation to metabolic acidosis is
a. accelerated
b. ineffective
c. limited - CORRECT ANSWER c. limited
A neonate born at 41 weeks gestation remains cyanotic despite oxygen administration. A soft systolic murmur can be heard on auscultation. A chest x-ray reveals a increased size heart with decreased pulmonary vascularity. These findings are consistent with
a. atrial septal defect
b. coarctation of the aorta
c. pulmonary atresia - CORRECT ANSWER c. pulmonary atresia
Parents of an infant with prune belly syndrome need to be advised about future development of
a. biliary disease
b. hypertension
c. renal obstruction - CORRECT ANSWER c. renal obstruction
A 36 week gestational aged preterm neonate is delivered via cesarean because of fetal distress. At birth the infant is depressed with Apgar scores of 4 at 1 minute, 4 at 5 minutes, and 6 at 10 minutes. An anticipated consequence of this birth would be
a. hypo-ischemic encephalopathy
b. intraventricular hemorrhage
c. subgaleal hemorrhage - CORRECT ANSWER a. hypo-ischemic encephalopathy
A factor that would result in increased insensible water loss in neonates is
a. hypothermia
b. postmaturity
c. tachypnea - CORRECT ANSWER c. tachypnea
Hemorrhagic disease of the newborn is attributed to a deficiency of vitamin K dependent factors. Additional predisposing characteristics include
a. administration of antenatal steroids
b. breastfeeding
c. maternal diabetes mellitis - CORRECT ANSWER b. breastfeeding
Interventions to decrease conductive heat loss in the delivery room include
a. providing additional heat source during bath
b. using transparent plastic covering over the infant
c. warming the incubator mattress - CORRECT ANSWER c. warming the incubator mattress
A differentiating characteristic for gastroschisis from omphalocele is
a. enlarged umbilical ring
b. herniated liver
c. thickened, inflamed intestine - CORRECT ANSWER c. thickened, inflamed intestine
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 to take is
a. clear mouth and nose of secretions
b. suction mouth and trachea
c. intubate and suction trachea - CORRECT ANSWER a. clear mouth and nose of secretions
A decision to provide morphine to a dying infant is framed by the principle of
a. autonomy
b. nonmaleficence
c. justice - CORRECT ANSWER b. nonmaleficence
A premature neonate at seven weeks of age has had no passage of stool for 72 hours. Rectal examination accomplishes evacuation. The neonate shortly thereafter develops vomiting, and the abdomen has become distended. The most appropriate diagnostic test to obtain is
a. abdominal radiography
b. contrast enema
c. rectal biopsy - CORRECT ANSWER a. abdominal radiography
Clinical assessments that can differentiate seizures from jitteriness include movements that
a. are evoked by a stimuli
b. involve eye movements
c. stops with restraint of extremity - CORRECT ANSWER c. stops with restraint of extremity
During a physical examination of a 36 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 most likely due to
a. hypoglycemia
b. neurological impairment
c. prematurity - CORRECT ANSWER c. prematurity
A late preterm infant presents with recurrent oral thrush. The most likely source would be
a. breast feeding
b. nipple feeding
c. pacifier - CORRECT ANSWER a. breast feeding
hysical examination of a newborn's head shows a fluctuant swelling crossing suture lines with extension into the neck with mild pitting edema. The nurse should recognize that
a. a cranial x-ray is indicated
b. the blood pressure should be monitored closely
c. this is a physiologic variable and no intervention is indicated - CORRECT ANSWER b. the blood pressure should be monitored closely
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. gentle kneading of the tube is indicated
b. this indicates the tube is patent and functional
c. tube position needs to be reassessed - CORRECT ANSWER b. this indicates the tube is patent and functional
A neonate is on a ventilator for respiratory distress syndrome. Ventilator settings are: PIP: 26; PEEP: 5; FiO₂: 1.0; Rate: 90. The neonate is given surfactant, and 18 hours later, the ventilator settings are: PIP: 11; PEEP: 4; FiO₂: 0.21; Rate 5. The nurse should recognize that
a. the FiO₂ should be increased
b. the neonate should be extubated to nasal CPAP
c. the settings are appropriate and will assist weaning - CORRECT ANSWER b. the neonate should be extubated to nasal CPAP
A neonate is born with bilateral dorsiflexion of the feet with limited plantar flexion and inversion. Exam reveals free mobility of the foot to passive manipulation. The nurse should recognize that
a. corrective surgery will be required
b. immobilization before three months is recommended
c. the neonate should be evaluated for hip dysplasia - CORRECT ANSWER c. the neonate should be evaluated for hip dysplasia
An infant is placed on 30% oxygen by nasal cannula 4 hours post-delivery for respiratory distress. An order is obtained for a pulse oximeter. The nurse should recognize that
a. oximeter readings are unaffected by the medication the infant may be receiving
b. the pulse oximeter gives a continuous measurement of hemoglobin oxygen saturation
c. the pulse oximeter will eliminate the need for obtaining arterial blood gas analysis - CORRECT ANSWER b. the pulse oximeter gives a continuous measurement of hemoglobin oxygen saturation
The picture shown depicts
a. clubfoot
b. metatarsus adductus
c. vertical talus - CORRECT ANSWER b. metatarsus adductus
During resuscitation the baby is not improving. Minimal chest movement and diminished breathe sounds persist despite positive pressure ventilation. The nurse should consider
a. giving Narcan
b. increasing pressures
c. intubating the infant - CORRECT ANSWER b. increasing pressures
The pattern of care provided to a neonate should be based on
a. initiation of aversive procedures during the quiet alert state to improve tolerance
b. performing procedures and interventions on a regular routine schedule allowing for adequate rest periods
c. the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it - CORRECT ANSWER c. the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it
A neonate was born to a mother who acquired varicella 4 days prior to delivery. The neonate should
a. be closely monitored and handled with universal precautions
b. receive acyclovir
c. receive varicella zoster immune globulin - CORRECT ANSWER a. be closely monitored and handled with universal precautions
A two week old 28 week gestation infant has developed skin excoriation from tape removal. Optimum management of the wound to promote healing will include
a. applying antibacterial cream instead of ointment
b. debriding with sterile water
c. keeping the area dry - CORRECT ANSWER b. debriding with sterile water
risk factor for bronze baby syndrome is
a. cholestasis
b. hypothyroidism
c. galactosemia - CORRECT ANSWER a. cholestasis
A neonate born at 37 weeks gestation has an initial physical examination which is normal in all respects except for mild lethargy and hypotonia. A maternal contributory factor for this finding is
a. anticonvulsant therapy with phenobarbital
b. diazepam sedation
c. magnesium sulfate therapy - CORRECT ANSWER c. magnesium sulfate therapy
Transepidermal water loss is
a. highest on the first day of life
b. influenced by antenatal steriods
c. not related to ambient relative humidity - CORRECT ANSWER a. highest on the first day of life
ABO incompatibility is most often a result of an
a. Type AB neonate born to a type O mother
b. Type A or B neonate born to a type O mother
c. Type O neonate born to a type A mother - CORRECT ANSWER b. Type A or B neonate born to a type O mother
The primary cardiovascular change in cor pulmonale is
a. Biventricular failure
b. Left ventricular hypertrophy
c. Right ventricular hypertrophy - CORRECT ANSWER c. Right ventricular hypertrophy
Most neonates with a small ventricular septal defect present with
a. central cyanosis
b. congestive heart failure
c. minimal left-to-right shunting - CORRECT ANSWER c. minimal left-to-right shunting
A mother asks why blanket rolls are placed around her premature infant. The nurse should advise that this is done to
a. minimize environmental noise
b. prevent injury
c. promote energy conservation - CORRECT ANSWER c. promote energy conservation
In the fetus, patency of the ductus arteriosis is maintained by:
a. high oxygen tension and progesterone
b. high oxygen tension and prostaglandin E2
c. low oxygen tension and prostagladin E2 - CORRECT ANSWER c. low oxygen tension and prostagladin E2
The method of surfactant administration that improves homogenous distribution of surfactant in lungs is
a. bolus injection
b. slow injection
c. ultrasonic nebulization - CORRECT ANSWER a. bolus injection
A major characteristic of autosomal recessive disorders is
a. consanguinity
b. multiple generations are affected
c. 50% risk for each offspring - CORRECT ANSWER a. consanguinity
A term neonate has hyponatremia with decreased urine sodium and reduced urine output. The most likely cause is
a. congenital or acquired reduction in antidiuretic hormone
b. inability of the neonatal kidney to appropriately regulate fluid & electrolyte homeostasis
c. overhydration secondary to administration of electrolyte-free IV fluids - CORRECT ANSWER b. inability of the neonatal kidney to appropriately regulate fluid & electrolyte homeostasis
A risk factor for intraventricular hemorrhage (IVH) is
a. decreased venous pressure
b. greater than 41 weeks gestation
c. hyperviscosity - CORRECT ANSWER a. decreased venous pressure
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 at
a. four months
b. six months
c. twelve months - CORRECT ANSWER b. six months
A condition associated with meconium ileus syndrome is
a. cryptorchidism
b. cystic fibrosis
c. persistent constipation - CORRECT ANSWER b. cystic fibrosis
When levels of PEEP are increased, they can worsen acute lung injury due to
a. barotrauma
b. excessive tidal volume
c. low lung volumes - CORRECT ANSWER a. barotrauma
A neonate who is being breastfed develops breastfeeding jaundice. The nurse should advise the mother to
a. increase the frequency of breastfeeding
b. supplement feedings with formula
c. temporarily stop breastfeeding and resume in 48 hours - CORRECT ANSWER a. increase the frequency of breastfeeding
A neonate is born to a mother with active syphilis. The infant screening titers are lower than those of the mother, and the infant has no symptomatology. The next course of action would be to
a. obtain a lumbar puncture
b. repeat titers in one to two months
c. no evaluation and no treatment - CORRECT ANSWER c. no evaluation and no treatment
Which event is most likely to present with irritability?
a. hypercalemia
b. hyperkalemia
c. hypermagnesemia - CORRECT ANSWER a. hypercalemia [Show Less]