×

Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 10 of 25

181.

A nurse is caring for an infant who has sustained severe infiltration of aminophylline from intravenous therapy. The treatment indicated for this condition is direct injection into the affected tissue area with which of the following medications? 

  • Hyaluronidase

  • Norepinephrine

  • Epinephrine

  • Dopamine

Correct answer: Hyaluronidase 

A severe infiltration of aminophylline (a medication that is extremely irritating to the vein) should be treated by direct injection into the affected area with hyaluronidase (Vitrase). This medication is an enzyme that destroys extracellular barriers, allowing rapid diffusion and absorption of the extravasated fluid. It is best administered in five injections, inserted subcutaneously around the periphery of the extravasation site, and is ideally administered within one to two hours of the extravasation.

Aminophylline is a hypertonic solution (containing calcium) and should not be treated with vasoconstrictive medications such as epinephrine, norepinephrine, or dopamine because the vasoconstriction could persist with their use.

182.

Why have newborn screening programs been implemented in every state in the United States?

  • To identify, treat, and prevent potentially devastating medical conditions

  • To identify and treat phenylketonuria (PKU)

  • To collect DNA records on all infants born in the United States

  • To collect vital records and statistics to guide evidence-based research efforts

Correct answer: To identify, treat, and prevent potentially devastating medical conditions 

Inborn errors of metabolism, when unrecognized and untreated, can have severe consequences, including intellectual disability and death in extreme cases. Thus, the primary goal is to identify, treat, and prevent major sequelae whenever possible. Newborn screening accomplishes this goal for a growing number of disorders.

183.

Which of the following drugs is classified as a phosphodiesterase inhibitor and used to treat persistent pulmonary hypertension of the newborn (PPHN)?

  • Milrinone (Primacor)

  • Dobutamine

  • Theophylline

  • Inhaled nitric oxide (iNO)

Correct answer: Milrinone (Primacor)

Milrinone is a class III phosphodiesterase inhibitor with inotropic, lusitropic (myocardial relaxation), and vasodilator properties and is used to treat PPHN. It improves oxygenation (without compromising systemic blood pressure) by increasing PaO2, reducing FiO2, decreasing oxygen index and MAP, and improving base deficit(s) and plasma lactate levels. It is used for term and late-preterm neonates with PPHN who are nonresponders or have a suboptimal response to iNO. 

184.

Which of the following ethical principles is best defined by doing good for others?

  • Beneficence

  • Fidelity

  • Nonmaleficence

  • Justice

Correct answer: Beneficence 

Beneficence is an ethical principle defined as doing good or performing actions with the intent of benefiting another person. 

Fidelity (or promise-keeping) refers to the obligation to provide care to the best of one's ability. Nonmaleficence simply means to do no harm, and justice refers to fair treatment without discrimination.

185.

Immediately after an infant is delivered, what is the BEST intervention to minimize the risk of evaporative heat loss?

  • Drying an infant with prewarmed towels and wrapping them in warm blankets

  • Warming the room and placing the resuscitation table away from doors or drafts

  • Covering surfaces with a warm blanket or towel

  • Placing an infant under an overhead radiant heater

Correct answer: Drying an infant with prewarmed towels and wrapping them in warm blankets

At birth, most heat loss results from the evaporation of amniotic fluid from the baby's skin surface. Drying the infant with prewarmed towels, immediately replacing used towels with dry ones, and wrapping the infant with warm blankets can minimize evaporative heat loss. In addition to these strategies, placing the infant skin-to-skin with their mother immediately following delivery (if both patients' conditions allow) is an excellent intervention to prevent heat loss via evaporation. 

Conduction is the loss of heat to a cooler object in direct contact. Thus, cold examiner hands, stethoscopes, scales, and bare mattresses can add significant cold stress if not warmed before coming into contact with a newborn. Placing the infant skin-to-skin with their mother immediately after delivery can also drastically minimize heat loss via conduction.

Warming the newborn care area and placing the resuscitation table away from doors or drafts will minimize convective heat loss. Placing an infant under an overhead radiant heater can limit radiant heat loss.

186.

In NICU patients, which of the following indicates shunt failure for those with a ventriculoperitoneal (VP) shunt?

  • Increasing lethargy

  • Sunken fontanelles

  • Absence of bowel sounds

  • Fever

Correct answer: Increasing lethargy

An infant with a VP shunt who is becoming increasingly lethargic has a likely increase in intracranial pressure (ICP) and an occluded shunt that is failing.

Sunken fontanelles indicate excessive drainage of cerebrospinal fluid and dehydration. An absence of bowel sounds indicates possible ileus. A fever indicates a shunt infection, not a malfunction.

187.

A healthy term newborn requires how many kcal per kg per day for sufficient growth and development?

  • 90 to 120 kcal/kg/day

  • 80 to 100 kcal/kg/day

  • 110 to 130 kcal/kg/day

  • 70 to 90 kcal/kg/day

Correct answer: 90 to 120 kcal/kg/day

Caloric requirements for near-term and term infants are 90 to 120 kcal/kg/day. Caloric requirements for preterm infants, including very-low-birth-weight (VLBW) and small-for-gestational-age (SGA) infants, are approximately 110 to 130 kcal/kg/day. 

Parenteral requirements are about 20% lower, or approximately 80 to 90 kcal/kg/day.

188.

A nurse is caring for an infant with a newly placed ventriculoperitoneal (VP) shunt. Which of the following nursing interventions should be included in the postoperative care of this infant?

  • Observe for symptoms of increased intracranial pressure, turn the infant every two hours from the unaffected side of their head to their back, observe for fluid leakage around the pump, and observe for signs of ileus 

  • Observe for signs of decreased intracranial pressure, pump the shunt every two hours, observe and document all intake and output, and observe for signs of ileus

  • Observe for signs of increased intracranial pressure, observe for signs of potential infection, perform range-of-motion exercises on all extremities, and position the infant on the shunt side once the incision has healed

  • Observe for signs of decreased intracranial pressure, infection, or ileus and use strict aseptic techniques when changing the dressing

Correct answer: Observe for symptoms of increased intracranial pressure, turn the infant every two hours from the unaffected side of their head to their back, observe for fluid leakage around the pump, and observe for signs of ileus 

The nurse should observe the patient for signs of increased intracranial pressure, not decreased intracranial pressure. The infant should always be positioned on the unaffected side, except for positioning on the shunt side with a "doughnut" over the operative site only after the incision has healed. The nurse should pump the shunt and only as directed by the neurosurgeon. 

189.

A nurse is caring for a full-term infant born to a mother with gestational diabetes; the infant is large for gestational age (LGA). 

What is the presumed cause of fetal macrosomia in this scenario?

  • Maternal hyperglycemia resulting in fetal hyperinsulinemia

  • Inherited predisposition for a larger body habitus

  • Likelihood of prolonged pregnancy and a post-term delivery, resulting in increased fetal weight gain

  • Fetal pancreatic beta-cell hypoplasia

Correct answer: Maternal hyperglycemia resulting in fetal hyperinsulinemia 

Fetal macrosomia (greater than the 90th percentile for weight) occurs in 25% to 42% of diabetic pregnancies because of hyperinsulinemia. 

Throughout pregnancy and particularly in the final trimester, a diabetic mother is increasingly insulin resistant and often has hyperglycemia and hyperaminoacidemia. The excess glucose and amino acids are transferred to the fetus, stimulating the fetal pancreas to produce insulin and to use the excess fuel. Fetal hyperinsulinemia then stimulates protein, lipid, and glycogen synthesis, causing a high rate of fetal growth.

190.

Apnea of prematurity may be classified as all the following, EXCEPT:

  • Tangential apnea

  • Obstructive apnea

  • Central apnea

  • Mixed apnea

Correct answer: Tangential apnea 

Apnea is the cessation of breathing for 20 seconds or longer or cessation of breathing for 15 seconds with cyanosis and/or bradycardia. Apnea of prematurity or primary apnea is not associated with other specific disease entities. The younger a patient's gestational age is, the greater their incidence of apnea.

Apnea is traditionally classified as central (absence of breathing effort), obstructive (breathing efforts occur, but the airway is blocked), or—most commonly—mixed (initial central apnea followed by obstruction of the airway). Various conditions can cause apnea, including infection, respiratory distress, cardiovascular diseases, GI and/or metabolic disorders, and neuronal immaturity.

191.

More than 90% of infants with meconium ileus also have which of the following conditions?

  • Cystic fibrosis

  • Down syndrome

  • Turner syndrome

  • Von Willebrand disease

Correct answer: Cystic fibrosis

Cystic fibrosis (CF), a three base-pair deletion on chromosome 7, is an autosomal-recessive gene defect resulting in alteration of the chloride channel transporter. This allows fluid to flow across the apical surface of epithelial cells. 

Although meconium ileus has been reported in a few patients without CF, it is the predominant cause of meconium ileus in infants (a mechanical obstruction of the distal ileum due to intraluminal accumulation of thick, inspissated meconium). 

192.

Which of the following interventions is the MOST appropriate when the nurse is providing skincare to an extremely low-birth-weight (ELBW) infant? 

  • Maintaining incubator humidity between 70% and 85% during the first two weeks of life, then decreasing to 50% after week two as tolerated

  • Maintaining incubator humidity between 80% and 90% during the first two weeks of life

  • Maintaining incubator humidity at 80% during the first two weeks of life and decreasing to 50% unless the infant is under phototherapy for hyperbilirubinemia 

  • Avoid humid conditions in the incubator because preterm infants have a larger proportion of extracellular fluid (ECF) than intracellular fluid (ICF), and humidity can cause fluid overload

Correct answer: Maintaining incubator humidity between 70% and 85% during the first two weeks of life, then decreasing to 50% after week two as tolerated

The optimal humidity level for a neonate is 50% relative humidity (RH). However, in the first two weeks after birth, extremely premature infants may require up to 85% RH to reduce insensible water loss (IWL) for an extremely premature or ELBW infant. Thereafter, it is reasonable to reduce the humidity to 50% as tolerated by the infant.

An ELBW infant has a greater proportion of ECF to ICF; therefore, humidity is needed due to increased IWL. An infant under phototherapy may require total IV fluids due to increased IWL.

193.

Antiviral agents such as ganciclovir, foscarnet, valganciclovir, and cidofovir are the only licensed antiviral agents effective against cytomegalovirus (CMV) for neonates. What is a significant adverse effect of IV ganciclovir (Zirgan) therapy?

  • Neutropenia

  • Hearing loss

  • Thrombocytopenia

  • Nephrotoxicity

Correct answer: Neutropenia

Ganciclovir, foscarnet, valganciclovir, and cidofovir are approved only for the treatment of life- and sight-threatening diseases. IV ganciclovir therapy for infants with CMV can prevent hearing deterioration caused by the virus; however, a significant adverse effect of this antiviral agent is neutropenia. Thus, antiretroviral therapy for congenital CMV infection is recommended only for infants with evidence of CNS involvement (e.g., sensorineural hearing loss), and/or end-organ disease (e.g., thrombocytopenia or hepatitis) who can start therapy within the first month after birth. 

194.

Surfactant therapy for the treatment of respiratory distress syndrome (RDS) in premature infants has been well studied in which of the following types of clinical research?

  • Randomized controlled trials (RCTs)

  • Single case or case series reports without controls

  • Nonrandomized studies with historical controls

  • Nonrandomized studies with concurrent controls

Correct answer: Randomized controlled trials (RCTs)

Surfactant therapy in premature neonates has been well studied in RCTs. Studies have evaluated the use of surfactant in the treatment of RDS, and morbidity and mortality rates in treatment and control groups have been compared. Systematic reviews of surfactant therapy confirm the effect of surfactant therapy in reducing the risk of morbidity and mortality.

195.

During a preterm infant's initial admission, all the following interventions are needed to maintain thermoregulation, EXCEPT: 

  • Maintain the skin temperature at 36.5 to 37.5 degrees Celsius

  • Facilitate skin-to-skin contact with parent(s)

  • Delay or defer bathing

  • Use warm water on the skin before applying probes and/or electrodes

Correct answer: Maintain the skin temperature at 36.5 to 37.5 degrees Celsius

The skin temperature of a preterm infant should be maintained at 36 to 36.5 degrees Celsius to maintain adequate thermoregulation. Temperatures should be maintained between 36.5 and 37.5 degrees Celsius axillary for a term infant.

Kangaroo care should be provided by a parent, as this warms infants better than incubator care. Linens, scales, radiant warmers, and incubators should be prewarmed. Infants should be positioned appropriately to decrease heat loss (i.e., prone, flexion). Warm water should be used on the skin before applying probes and electrodes, and bathing should be delayed or deferred for preterm infants.

196.

Which condition is caused by severe intrauterine anemia of any origin and is characterized in a fetus by congestive heart failure, massive skin edema, and intrauterine demise, especially during the first two trimesters?

  • Hydrops fetalis

  • Hemoglobinopathy

  • Disseminated intravascular coagulation (DIC)

  • Congenital platelet dysfunction

Correct answer: Hydrops fetalis 

Hydrops fetalis is a severe, life-threatening condition of massive edema in fetuses and newborns. There are two types of hydrops fetalis:

  • Immune: This results when the mother's immune system causes a breakdown of red blood cells in the fetus. This is the most dangerous complication of blood group incompatibility between the mother and baby. This form is uncommon because of the widespread use of Rh immunoglobulin treatment for Rh-negative women. 
  • Nonimmune: This is the more common type. It can result when diseases or complications interfere with a baby's ability to manage fluid.

Rh incompatibility is a common cause of hydrops fetalis; it prompts numerous red blood cells in the fetus to be destroyed (also known as hemolytic disease of the newborn).

197.

An infant born at 30 weeks of gestation and weighing approximately 1,500 g requires endotracheal (ET) intubation. What size endotracheal tube (ETT) is appropriate for this neonate? 

  • Size 3

  • Size 3.5

  • Size 4

  • Size 2.5

Correct answer: Size 3

ETT size and depth of insertion parameters are as follows: 

  • size 2.5 for infants weighing <1,000 g (<28 weeks of gestation) with <7 cm depth from the upper lip
  • size 3 for infants weighing 1,000 to 2,000 g (gestational age 28-34 weeks) with 7 cm depth from the upper lip
  • size 3.5 for infants weighing 2,000 to 3,000 g (>34 weeks of gestation) with 8 cm depth from the upper lip
  • size 3.5 to 4 for infants weighing more than 3,000 g (>40 weeks of gestation) with 9 cm depth from the upper lip

A laryngoscope with a blade should be size 0 for infants weighing <3 kg and size 1 for infants weighing >3 kg. 

198.

What is the MOST commonly diagnosed viral infection in the NICU?

  • Enterovirus infection

  • Group B streptococcus (GBS) infection

  • Chlamydia trachomatis infection

  • Herpes simplex infection

Correct answer: Enterovirus infection

Enterovirus infections—including coxsackieviruses A and B, echovirus, and poliomyelitis—are the most commonly diagnosed viral infections in the NICU. Coxsackievirus B1 was the most common in 2007.

Poliomyelitis can be prevented with active immunization of the mother prior to conception. Only inactivated poliovirus vaccine (IPV) should be used in the nursery. Hand hygiene is vital to help control the spread of enteroviral infections within the NICU. Intravenous immunoglobulin can be effective for severe enteroviral infections.

199.

All the following findings are critical to the diagnosis of Hirschsprung's disease, EXCEPT: 

  • The presence of ganglion cells and nerve hypertrophy on rectal biopsy

  • Failure to pass meconium within 48 hours of life

  • Feeding intolerance and abdominal distention

  • Enterocolitis

Correct answer: The presence of ganglion cells and nerve hypertrophy on rectal biopsy

Hirschsprung's disease is a congenital intestinal disorder causing disruption of effective peristalsis. Critical findings include all the following: 

  • failure to pass meconium within the first 48 hours after birth
  • feeding intolerance
  • abdominal distention
  • enterocolitis (fever, abdominal distention, foul-smelling diarrhea, sepsis)
  • transition zone on barium enema
  • absent ganglion cells and nerve hypertrophy on rectal biopsy

On histology, a biopsy that is diagnostic for Hirschsprung's disease shows an absence of ganglion cells and the presence of hypertrophic nerve trunks within the submucosal and intermyenteric plexus. Conversely, if ganglion cells are observed on histologic examination, the diagnosis is excluded. 

200.

For infants with respiratory distress syndrome (RDS), what do grunting, nasal flaring, and chest retractions represent?

  • An attempt to maintain a normal functional residual capacity (FRC)

  • An attempt to conserve energy

  • An attempt to decrease upper airway resistance

  • An attempt to overcome airway obstruction

Correct answer: An attempt to maintain a normal functional residual capacity (FRC)

For infants with RDS, their immature lung anatomy and physiology cannot support oxygenation and ventilation, and functional residual capacity is reduced. The diaphragm contracts, creating an inspiratory pressure that moves less volume into the lungs than expected and simultaneously causes large sternal and intercostal retractions of the chest wall. In addition, infants with RDS are often tachypneic and demonstrate grunting, along with pallor or cyanosis.

Energy conservation is important for sick infants and is typically demonstrated by decreased tone and activity. Upper airway resistance is a function of nasal resistance and the cartilage supporting structures of the pharyngeal airway. Large airway obstruction is caused by mucus or congenital defects and is not relieved by grunting, flaring, or retracting.

×