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CCRN Neonatal Questions & Answers
A deformation is a(n) - ✔abnormality caused by unusual mechanical forces on normal tissue. A low birth weight infant's temperature increases during skin-to-skin care. This is an example of heat transfer by - ✔conduction. At the onset of labor the release of catecholamines stimulates - ✔increased absorption of lung fluid. An edematous, bruised lesion on the right anterior scalp where the vacuum was applied. This lesion has clearly demarcated edges, is firm to touch, and does not cross the suture line. This is best described as a - ✔cephalohematoma. An infant born at 40 5/7 weeks gestation and weighed 5 lbs 2oz (2,360 grams). In completing a gestational age assessment on this infant, you would identify her as - ✔term, small for gestational age. During fetal life, the ductus arteriosus - ✔diverts blood flow from the pulmonary artery to the descending aorta. Expected findings in a neonate born to a mother who received magnesium sulfate in labor include - ✔hypotonia. Eye prophylaxis with a single-use dose of sterile ophthalmic ointment containing 1% tetracycline or 0.5% erythromycin is usually administered within the first few hours of birth to prevent an eye infection caused by - ✔gonorrhea. Following a birth complicated by shoulder dystocia, the neonate should be assessed for - ✔Erb's palsy. Preeclampsia may result in all of the following fetal conditions - ✔growth restriction, hypoxia/neurological injury, prematurity. Hyperthermia is defined as an axillary temperature greater than 99.5ºF (37.5ºC). The MOST common cause of hyperthermia in the newborn is - ✔environmental. In the immediate newborn transition period, the ability to maintain functional residual lung capacity is most dependent upon - ✔an adequate amount of alveolar surfactant. Neonates at risk of hypoglycemia should have their glucose levels evaluated within 2 hours of life because - ✔blood glucose levels reach their lowest point within one to two hours after delivery. Polycythemia in the immediate newborn period is often associated with - ✔infant of a diabetic mother. Symptoms of mild perinatal asphyxia include - ✔hyperalert state and jitteriness. The condition in which the newborn's immature hypothalamus does not regulate peripheral blood vessels, resulting in a vasoconstriction on one side of the body with a vasodilation on the opposite side of the body is called - ✔harlequin phenomena. The following conditions may all lead to metabolic acidosis -
✔loss of HCO3/excess acid load d/t prematurity, renal tubular necrosis, severe diarrhea, hypoxia, hypoperfusion, inborn errors of metabolism, caloric deprivation, intolerance of cow's milk protein. The full newborn cardiovascular assessment includes auscultation, inspection, and palpation. The point of maximum impulse is usually palpable and can be auscultated in the - ✔third to fourth intercostal space and left of the midclavicular line. The neonate born to a mother with uncontrolled diabetes mellitus should be evaluated for - ✔congenital malformations. You are the nurse caring for a 38 weeks gestation, female infant, who was born one hour ago in the parking lot of the emergency room. On admission to the nursery, the neonate's rectal temperature was 95ºF (35ºC). You recognize that cold stress may predispose the infant to - ✔increased oxygen consumption and hypoxia. A full term neonate who presents at six hours of age with increasingly labile oxygenation that appears disproportionate to the pulmonary disease should be evaluated for - ✔pulmonary hypertension of the newborn. The development of pneumonia in chronically ventilated infants is most commonly associated with which of the following organisms? - ✔Ureaplasma urealyticum Antenatal steroids enhance lung maturation by - ✔increasing the number of type II pneumocytes in the lung. Mean airway pressure is defined as the - ✔pressure transmitted to the lung throughout the respiratory cycle. Many infants with the diagnosis of persistent pulmonary hypertension (PPHN) will have pharmacologic support. Identify the medication that is a direct-acting vasodilator and acts by relaxing pulmonary vessel musculature. - ✔Nitric oxide The following arterial blood gas results: pH 7.28, PaO2 74, PaCO2 55, HCO3- 21 and base deficit -4 indicate - ✔respiratory acidosis. Nastassia is a one-hour-old neonate, born at 39 weeks gestation by primary cesarean birth for fetal bradycardia. She was hypotonic at birth with gasping respirations and a heart rate of 80. She was provided bulb suctioning and bag mask ventilation and recovered by five minutes of life. On admission to the NICU, her temperature was 36° C. After admission to the NICU, her arterial blood gas is pH: 7.19, PCO2: 63, HCO3: 14. The correct interpretation of this blood gas is - ✔mixed respiratory and metabolic acidosis. Which statement is most accurate when identifying the pathophysiology of transient tachypnea of the newborn (TTN)? - ✔Labor enhances the process of fetal lung fluid absorption During which phase of fetal pulmonary development do the type II pneumocytes become numerous and begin to produce and store surfactant? - ✔Canalicular phase An absence of air flow despite respiratory effort is an example of which apnea classification? - ✔Obstructive apnea Continuous positive airway pressure (CPAP) improves oxygenation by -
✔indomethacin. Parallel circulations in which there are separate pulmonary and systemic circulatory systems occur in - ✔transposition of the great vessels. Pulmonary venous congestion is most commonly identified with which of the following defects? - ✔Hypoplastic left heart Pulse oximetry screening for critical congenital heart disease (CCHD) is most accurate when performed when the infant is how many hours of age? - ✔24 hours or more The best option for volume replacement in an infant with disseminated intravascular coagulopathy is - ✔FFP (fresh, frozen plasma). The major structural anomaly associated with total anomalous pulmonary venous return (TAPVR) includes pulmonary - ✔veins failing to be incorporated in the left atrium. The valve located between the left atrium and left ventricle is called the - ✔mitral. Which is the most prevalent theory of the etiology of congenital heart disease? - ✔Multifactorial etiology How does the neonate respond to increase cardiac output? - ✔Tachycardia is the main neonatal cardiac response to increase cardiac output. Which of the following defects increases blood flow to the lungs? - ✔Patent ductus arteriosus Which of the following is the most controversial management strategy for treatment of congestive heart failure in the preterm neonate? - ✔Digoxin therapy What are the symptoms of congestive heart failure? - ✔Tachypnea, tachycardia, central or prolonged peripheral cyanosis, BP higher in R arm than either leg, arrhythmias, poor feeding, cardiomegaly on CXR, hepatomegaly, pulmonary fine or coarse rales. Which of the following organs forms first in the embryo? - ✔Heart Which statement lists the four defects that make up the tetralogy of Fallot? - ✔Pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, ascending aorta overriding the ventricular septal defect Which term describes the combination of the pressure on the ventricular walls caused by the volume of blood inside those walls and follows the principles of the Frank-Starling law? - ✔Preload Which types of shock are commonly seen in the infant who is septic? - ✔Distributive and hypovolemic With a complete endocardial cushion defect, blood will flow - ✔freely among all four chambers of the heart. An infant whose birth weight is at what percentile on the growth chart is at increased risk for hypoglycemia due hyperinsulinism? - ✔97th At how many weeks gestation is suck-swallow-breathe coordination present? - ✔34- Compared to full term formulas, preterm formulas contain -
✔more calories and increased protein. Complications of percutaneous central venous lines - ✔catheter migration. Depending on the amount of weight loss, electrolyte values, and markers of renal function, fluid is usually administered at which rate in the first 48 hours of life? - ✔60-100 ml/kg/day Disadvantages associated with continuous gavage feedings include all of the following EXCEPT? - ✔Decreases in the amount of gastric acid in the stomach Gluconeogenesis is the process of converting - ✔non-glucose precursors to glucose. In which of the following conditions is the neonate MOST at risk for hypokalemia? - ✔Increased gastrointestinal losses Insensible water losses occur primarily through - ✔respiratory and cutaneous routes. Jeremiah was born via emergent cesarean birth at 38 weeks gestation after a complete abruption. He required a full resuscitation, and his Apgar scores were 1 at 5 minutes, 3 at 7 minutes, and 5 at 10 minutes. He is currently on ventilatory support with a diagnosis of hypoxic ischemic encephalopathy. Jeremiah is MOST at risk for hypoglycemia because - ✔damage to the liver may impair synthesis of enzymes that facilitate glucose homeostasis. One of the advantages human milk has over formula is that it - ✔contains very long-chain fatty acids. Patient care management for the neonate with hypernatremia often includes - ✔monitoring for hyperglycemia and hypocalcemia. Preterm neonates have fewer glomeruli and tubular immaturity, which contribute to which of the following physiologic processes? - ✔Retention of sodium and bicarbonate, free water excretion, and decreased renal concentrating capacity Signs of renal compromise or severe fluid deficit will often include a urine output of less than - ✔0.5 ml/kg/hour. Symptoms of hyperkalemia include - ✔electrocardiographic changes and dysrhythmias. The purpose of trophic feeds is to - ✔stimulate functional development of the GI tract. What is the best treatment option for severe intractable hyperkalemia? - ✔Peritoneal dialysis What is the timeframe for early hyponatremia in the neonate? - ✔1-2 days When caring for a newborn on an insulin infusion, the glucose levels should be monitored how often during the initial titration of the drip? - ✔Every 15 minutes Which of the following does NOT cross the placenta from the mother to the fetus? - ✔Insulin Which of the following parties is MOST essential to the feeding experience of the NICU infant? - ✔Parent/family member Which substrate is the major source of fuel to the brain? -
What is the MOST common type of acute renal failure in the neonatal period? - ✔Prerenal When performing the initial physical assessment of a newborn, the nurse notices the genitalia are atypical. Which condition might be responsible for this disorder? - ✔Congenital adrenal hyperplasia Which of the following explains why a preterm infant is at greater risk for negative sodium balance? - ✔There is an increased proportion of water in the extracellular fluid compartment. Which of the following is a common abnormality associated with a hypospadias? - ✔Chordee Which of the following is a prerenal cause of acute renal failure? - ✔Hemorrhage failure of autoregulation to maintain renal blood flow and GFR; hypoperfusion; result of hypovolemia; hypotension Which of the following is an etiology for postrenal kidney failure? - ✔Fungal infection Urinary tract abnormalities, extrinsic obstruction of the urinary tract, fungal infections A common organism responsible for early onset sepsis is - ✔E. coli. MOST common is GBS A newborn with polycythemia may exhibit which of the following? - ✔Tachypnea, thrombocytopenia, hypoglycemia Anemia due to decreased red blood cell survival should be anticipated in the neonate with a history of - ✔isoimmune-mediated hemolysis. Bilirubin levels rise in an infant with severe gram-negative sepsis for which of the following reasons? - ✔Overproduction and decreased excretion of bilirubin Blood products administered to neonates are irradiated to prevent which of the following conditions? - ✔Graft-versus-host disease leukodepleted to prevent against graft v. host disease; irradiated to protect against CMV Complement works with the immune system to - ✔opsonize bacteria to facilitate phagocytosis. Diagnostic test results that indicate thrombocytopenia include - ✔decreased platelet count. During the process of hematopoiesis, the megakaryoblast matures to which of the following cells? - ✔thrombocytes (platelets) Hemoglobin values at birth are dependent upon - ✔gestational age and volume of placental transfer. Signs of polycythemia include - ✔congestive heart failure and pulmonary edema. also poor feeding and hypoglycemia; The cause of bleeding in a newborn with early stage vitamin K deficiency bleeding is typically related to - ✔maternal medications that impact synthesis and storage. usually occurs in the first 24 hours and is related to maternal medications that may interfere with stores or funtion of vitamin K; anticonvulsants, tuberculostatic agents, vitamin K antagonists. The initial antibiotic choice for infants with suspected meningitis includes -
✔ampicillin and a third generation cephalosporin amp and third gen cephalosporin (cefotax and ceftaz) The MOST accurate predictor of infection when analyzing white blood count is - ✔neutropenia. The MOST common cause of hyperbilirubinemia in the newborn is - ✔hemolytic disease. Which laboratory results are indicative of disseminated intravascular coagulopathy? - ✔Increased PT and PTT times also decreased platelet count, decreased coag factors, and increased fibrin split products Which of the following are associated with neonatal anemia? - ✔Discordant twins, placenta previa, elevated Kleihauer-Betke test Which of the following immunoglobulins cross the placenta? - ✔IgG Which of the following microorganisms is a causative agent for late onset sepsis? - ✔Candida albicans Which of the following statements is MOST accurate when describing the availability of albumin binding sites to bilirubin? - ✔Availability of bilirubin binding sites may be affected by poor nutrition, medications, or intralipids. Which of the following treatments may be used to decrease the need for exchange transfusion in the newborn with extreme or critical hyperbilirubinemia? - ✔Intravenous immunoglobulin Which statement best supports organizational recommendations for prevention of kernicterus or extreme hyperbilirubinemia? - ✔Provide follow up care based on the risk assessment at the time of discharge. promote and support bf, measure tcb w in 24 hours, measure all bili levels according to age in hours... Which type of phototherapy unit provides higher than with traditional fluorescent bulbs? - ✔LED banks and pads Which white blood cell is MOST effective in the destruction of parasites in neonates with a parasitic infection? - ✔Eosinophil You have initiated phototherapy for a two day old preterm newborn with hyperbilirubinemia. After six hours of phototherapy, the total serum bilirubin level is unchanged. What are your thoughts? - ✔Irradiance level should be checked and skin exposure maximized. Symptoms of Polycthemia - ✔Tachypnea, plethora, prolonged cap refill time Symptoms of Anemia - ✔Pallor tachycardia tachypnea Symptoms of Thrombocytopenia - ✔Petechiae, bleeding from IV site, bruising Function of granulocyte - ✔infection response Function of thrombocyte - ✔hemostasis Function of hemoglobin - ✔oxygen carrying protein Function of erythrocyte -
The purpose of a silo for abdominal defects is to - ✔Gradually reduce the bowel over several days. A hemorrhage associated with birth trauma that does NOT cross suture lines is called a - ✔cephalohematoma. A subgaleal hemorrhage is treated as a medical emergency because - ✔large blood loss may lead to hypovolemic shock. All of the following may predispose an infant to a subdural hemorrhage EXCEPT - ✔prematurity. shoulder dystocia, vaginal breech, instrument assisted An infant exhibiting apnea, bradycardia, decreased reflexes, hypotonia, and unequal pupillary reaction would be diagnosed with which stage of hypoxic ischemic encephalopathy? - ✔Stage III Autoregulation is a process that - ✔maintains steady-state cerebral blood flow despite changes in cerebral perfusion pressure. the ability to maintain steady-state cerebral blood flow despite changes in cerebral perfusion pressure; allows body to divert blood to where it is most needed; Baby Eduardo was born with anencephaly, a serious type of neural tube defect (NTD), and he died in the NICU two days after birth. His grieving parents ask the nurse if the risk of this birth defect can be reduced in a future pregnancy. Which is the BEST reply? - ✔"By taking a prescription dose of 4.0 milligrams of folic acid before a future pregnancy, you can reduce the risk of NTDs." Clinical presentation of subarachnoid hemorrhage - ✔increasing OFC, shock, vacuum-assisted delivery Clinical presentation of subdural hemorrhage - ✔increased ICP, instrumented delivery, coma Clinical presentation of subgaleal hemorrhage - ✔sever asphyxia, birth trauma, often asympotomatic, seizures on 2nd or 3rd day of life How much folic acid is recommended in the preconception period and in the first three months of pregnancy for women who have had a prior infant with a neural tube defect? - ✔4,000 mcg 4 mg (4000 mcg) starting at least one month before conception and through at least 3 months of pregnancy Management of the neonate with an intraventricular hemorrhage includes - ✔preventing wide swings in systemic blood pressure. Periventricular leukomalacia may be caused by all of the following physiologic conditions EXCEPT - ✔treatment with extracorporeal membrane oxygenation. Symptoms of subtle seizures include - ✔rowing, stepping, or pedaling movements. motor automatisms, buccolingual movements; most common and account for 1/2 of all seizures; found in preterm and term infants; rowing, stepping, pedaling movements, eye blinking/fluttering, staring, smacking of lips, drooling, sucking on ET tube The Arnold-Chiari II malformation is associated with which of the following neural tube defects? - ✔Myelomeningocele disruption of an already closed neural tube, malformation of the pons and medulla; accounts for 90% of lumbar myelomeningoceles
The bundle of fibers which connects the cerebral hemispheres is the - ✔corpus callosum. The definition of ischemia is a(n) - ✔decrease in the flow of blood available to perfuse the brain. a decrease in the flow of blood available to perfuse the brain; the ischemic process damages the cerebral blood vesseks as wekk as their surrounding support structures. The goals of neuroprotective cooling in infants with hypoxic ischemic encephalopathy include all of the following EXCEPT - ✔increasing the uptake of glutamate. Goal to inhibit brain cell necrosis by decreasing brain's metabolic rate, awakening excitatory amino acids, slowing the uptake of glutamate, decreasing the production of nitric oxide and free radicals The initial pharmacologic management of an infant with a seizure disorder is which of these medications? - ✔Phenobarbital loading dose 20 mg/kg IV over 10-15 minutes Which of the following are signs of hydrocephalus? - ✔Vomiting, lethargy, irritability Which of the following increases cerebral blood flow? - ✔Decreasing pH and hypoglycemia decreased pH, increased K+, hypoxemia, increased osmolarity, hypoglycemia (below 30) Which of the following is NOT a neural tube defect? - ✔Brachial plexus palsy Which of the following newborns meets the criteria for neuroprotective cooling? - ✔36 weeks, Apgar score of 3 at 10 minutes, cord arterial blood pH 7.05 35- wks gestation, >1800g, pH<7 with base defecit of >12-16, apgar score<3 at 5 or 10 minutes, and lack of respiratory effort at 10 min Which of the following risk factors predispose an infant to intraventricular hemorrhage? - ✔Preterm infant <28 weeks gestation with respiratory distress syndrome Which of the following skin lesions may be associated with neurofibromatosis? - ✔Café-au-lait spots Which statement about cerebral metabolism is FALSE? - ✔The brain uses lactic acid for fuel during anaerobic metabolism. A fluid accumulation in the dermal layer of the skin would be described as a - ✔wheal. A papule is defined as a - ✔solid, elevated lesion with distinct borders less than 0.5 cm in size. solid or fluid filled lesions that are elevated with distinct borders; less than 1 cm in diameter All of the following are guidelines for basic skin care of the neonate except - ✔bathe with mild soap and warm water once per day. Drying and separation of the umbilical cord is best facilitated by - ✔keeping the cord open to the air by folding the diaper down below the cord. Ebony is a 28 week gestation infant in the NICU on ventilatory support. During a routine shift assessment, you find that the IV has infiltrated. After application of hyaluronidase, you might consider which of the following interventions? - ✔Instilling multiple puncture holes with a 23 gauge needle. Hydrogel dressings such as Vigilon may be - ✔used after irrigation of an infected wound. Hyperpigmented or blue-gray macules are - ✔benign. Skin excoriations should be treated in the following way: -
If the neonate is symptomatic with a plasma glucose value of less than 40mg/dl (2. mmol/L) and is refusing or NOT tolerating feedings, the nurse should request orders for the following interventions: - ✔an intravenous bolus of 2 ml/kg D10W and an intravenous D10W infusion initiated at 80 ml/kg/day. In contrast to term newborns, bilirubin levels in late preterm newborns typically peak at - ✔5-7 days of life Late preterm infants may need additional time to meet the criteria recommended for discharge. Therefore, late preterm infants should NOT be discharged prior to - ✔48 hours of life. Parents should be taught to assess their infant's _________ temperature. - ✔axillary Routine nursing interventions to prevent hypoglycemia in the late preterm infant should include - ✔initiation of breastfeeding of all late preterm infants within the first hour of life. The components of safe sleep include the following EXCEPT - ✔sharing a sleep surface with parents. The dose for oral glucose gel for asymptomatic neonatal hypoglycemia is _____mg/kg body weight. - ✔ 200 The late preterm infant population is currently defined as infants who are born between - ✔34 to 36 6/7 weeks of gestation. The late preterm infant should meet the following discharge criteria: Successful feedings for - ✔24 hours and vital signs within normal limits for 12 hours prior to discharge. The late preterm newborn is at risk of developing hypothermia because of - ✔decreased ability to flex extremities The nurse should utilize the following interventions to promote successful breastfeeding in the late preterm infant EXCEPT - ✔providing supplementation after every feeding. Which of the following statements about the late preterm infant is TRUE? - ✔Body mass and fat stores are low and may impact the infant's ability to maintain normal temperatures. The MOST common screening tests for Down Syndrome offered to parents in the first trimester - ✔maternal serum alpha fetoprotein. Education for the parents of a neonate diagnosed with phenylketonuria (PKU) includes which of the following? - ✔✓ A low protein formula (diet) is necessary to avoid/ameliorate developmental delay. Which of the following is TRUE about neonates with achondroplasia? - ✔✓ The disorder can be inherited as an autosomal dominant condition. Education for parents of a male neonate diagnosed with an X-linked recessive single gene disorder would include - ✔✓ all of his daughters will be obligate carriers. The predominant difference between single-gene disorders and multifactorial disorders is that in multifactorial disorders - ✔✓ they are caused by a combination of genetic and environmental influences.
A deformation is a(n) - ✔abnormality caused by unusual mechanical forces on normal tissue. Blood specimens placed on filter paper for newborn screening should be - ✔dried in air at room temperature for three hours before being placed in the envelope. Fetal alcohol syndrome is the most serious form of fetal alcohol spectrum disorder. Which is NOT TRUE about fetal alcohol syndrome? - ✔Fetal alcohol syndrome only happens if the mother is an alcoholic. Nondisjunction is defined as - ✔the failure of paired chromosomes to separate equally during cell division. A 7-day-old neonate with an unremarkable hospital course who now presents with increasing episodes of hypoglycemia, severe metabolic acidosis, recurrent vomiting, and high ammonia levels should be evaluated for what disorder? - ✔✓ An inborn error of metabolism Complex/multifactorial anomalies - ✔have a recurrence risk dependent upon how closely related the affected person is to the neonate. An infant born at 36 weeks gestation is small for gestational age and hypotonic. Her physical exam yields low set, "fawn-like" ears and micrognathia. A renal ultrasound shows horseshoe shaped kidneys. She also has a loud, audible murmur and an echocardiogram yields a large VSD. Which congenital anomaly do you suspect? - ✔Edwards syndrome A clinical feature commonly found in a neonate with Down syndrome is - ✔hypotonia. A post-op infant is exhibiting tachycardia, oxygen desaturations, and elevated blood pressure. She received a dose of Fentanyl 1.5 hours ago. Which of the following is the MOST appropriate action? - ✔Reposition the infant with arms and legs flexed. A non-pharmacologic intervention that modulates the transmission or processing of nociception through mediation by the endogenous nonopioid system is - ✔Non nutritive sucking; sweet tasting solutions According to the Synactive Theory of Development, the autonomic subsystem is responsible for which of the following? - ✔Regulating cardiopulmonary activity regulates cardiopulmonary activity, GI peristalsis, peripheral skin blood flow All of the following interventions promote positive maturation of the auditory system EXCEPT - ✔sterile hospital workspace or environment. Barriers to normal development include all of the following - ✔separation from parents,numerous care providers, medically necessary equipment, medications and adverse effects, artificial schedules, continuous sensory stimulation Both cortical and brainstem auditory-evoked responses can be elicited at which of the following postmenstrual ages? - ✔25-28 weeks Circadian rhythms - ✔24 hour cycles that are produced by an internal biological clock; regulates the sleep wake cycle and changes in hormone levels Development of the visual system requires -
✔Familiarizing the newborn with the odor of breastmilk or formula Which of the following statements about the subsystems of the Synactive Theory of Development are TRUE? - ✔Organization is critical for energy consumption, caloric requirements, and growth. Which pain scoring tool was researched in preterm and full-term infants who required capillary, venous, or arterial punctures and is useful for newborns who are NOT on cardiorespiratory monitoring? - ✔NIPS (Neonatal Infant Pain Scales) Within hours of birth, the neonate signals to the mother that they are hearing her voice by - ✔sucking faster on a pacifier. turn eyes and head toward the mothers voice and sucking faster on a pacifier All of the following neonatal pain scoring tools have been tested on newborns EXCEPT - ✔PIPP (Premature Infant Pain Profile), NIPS (Neonatal Infant Pain Scales), CRIES (Crying, Required Oxygen, Increased Vital Signs, Expression, Sleeplessness) have been used Benefits of skin-to-skin (kangaroo) care include - ✔improved thermoregulation and cardio function, decreased incidence/severity of infections, increased weight gain, non pharmacologic intervention, enhanced physiologic organization, improved breastfeeding outcomes, increased alertness and exploration of the environment A preterm birth may delay the following steps of attachment from occurring EXCEPT
- ✔accepting the pregnancy. A sign that parents are experiencing acute stress disorder includes - ✔having flashbacks of the trauma. Evidence that the psychological task of acknowledging guilt about the birth of a 26- week gestational age neonate has become pathologic includes - ✔not responding to the neonate's progress because the infant represents failure. In the nine steps of attachment, "confirming the pregnancy" refers to the - ✔beginning of the mother's psychological acceptance that she is pregnant. Interventions for the family in crisis include which of the following? - ✔Holding discussions when the mother and father are together NICU nurses who experience secondary traumatic stress may benefit from - ✔participating in a case review or debriefing. Predictors of negative parenting outcomes include which of the following? - ✔Infrequent visits that are for short periods of time Predictors of positive parenting outcomes include which of the following? - ✔Asking meaningful questions about the infant The birth of a infant with congenital anomalies is a situational crisis that may be used to - ✔maximize a family's adaptation and reorganization. The birth or death of a sick or preterm neonate may place families in a state of crisis, defined as - ✔a temporary disequilibrium caused by events so stressful that customary coping skills are ineffective. The nurse should recognize that the mother is experiencing signs of grief when she -
✔is preoccupied with the image of her lost baby. The psychological task of anticipatory grieving involves - ✔parental acknowledgement that the infant is at risk for death while hoping for survival. The single, teenage father may have additional difficulties when he attempts to be a parent because he - ✔may not be recognized as having any parental rights. When providing interventions for families experiencing perinatal loss, the nurse should - ✔be an active listener and provide information regarding support groups. A communicating hydrocephalus results from damage to the - ✔arachnoid granulations. arachnoid granulations over the surface of the brain According to the AAP, intubation attempts should be limited to ______seconds. - ✔30 seconds An underpenetrated x-ray may result in over diagnosis of - ✔respiratory distress syndrome. Chlorhexidine should be used with caution in infants less than what age? - ✔2 months Damage to the calcaneus is more likely when a heel stick is performed using what part of the foot? - ✔End of the heel Extravasation injury is more common when IV solutions containing _________ are infused. - ✔calcium Of the following veins, which would be the best choice for inserting a peripheral IV? - ✔Dorsum of the hand Positioning the tip of an umbilical catheter in the heart increases the risk of - ✔arrhythmia. Prior to intubation, an anticholinergic drug may be given to reduce the incidence of - ✔bradycardia. The appropriate depth for an endotracheal tube can be calculated by measuring the distance from the nasal septum to the tragus of the ear and adding ___ cm? - ✔1 cm The depth of insertion for an orogastric tube is determined by measuring the distance from the mouth to ear and then to the bottom of the - ✔xiphoid process. The optimal item to use when securing a PIV is - ✔a transparent dressing. The tip of an appropriately positioned endotracheal tube should be how far above the carina? - ✔1 cm Umbilical venous catheters (UVC) provide central venous access for glucose infusions that exceed what concentration? - ✔12.5% Venipuncture is indicated when - ✔the heels are too edematous or damaged. What is the smallest gauge of needle recommended for transfusion of red blood cells for the neonate? - ✔24 gauge When collecting free-flowing blood for a serum ammonia test, applying pressure will -
Which of the following is an accurate statement about human milk oral care for the NICU infant? - ✔Infants can absorb immune components of human milk through their buccal mucosa. Using test weights to evaluate milk transfer during direct breastfeeding has been found to - ✔accurately measure breastfeeding adequacy. If a NICU infant is unable to sustain a latch to the breast, what would be an appropriate intervention? - ✔Educate the mother on the use of a nipple shield. What is the most important measure in relieving engorgement? - ✔Frequent and effective milk removal via pumping or direct feeding A mother is concerned regarding the safety of her medications and breastfeeding. What is the best nursing intervention to reassure and support the woman's breastfeeding goals? - ✔Find information on the safety of the medications while breastfeeding to share with her. Baby Beatrice is a preterm infant who is now 14 days old. The infant's mother was discharged home at 72 hours. How much milk should the mother be producing per 24 hours by day 14? - ✔500-600 ml At the 14-day-old pediatric visit for a preterm Baby, her mother states she is pumping four times a day, and her 24-hour milk volume is 300 milliliters. What would be the best response? - ✔"Let's talk about how to increase the number of pumping sessions to 8 or more in a 24-hour period." Which of the following statements accurately describes the ability of infants to transition to breastfeeding? - ✔There is no research to support that infants need to be a certain gestational age to transition to the breast. How soon after birth should a mother ideally initiate pumping and with what type of pump? - ✔within 1 hour
