×

Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 4 of 25

61.

Why do hyperlipidemia and hyperglycemia appear concurrently in an infant of a diabetic mother (IDM)?

  • Lipid breakdown is inhibited by hyperinsulinemia

  • VLDL (very-low-density lipoprotein) production increases in response to increased insulin production

  • Insulin resistance promotes VLDL (very-low-density lipoprotein) production

  • Lipid breakdown is accelerated by hyperinsulinemia

Correct answer: Lipid breakdown is inhibited by hyperinsulinemia

The pancreas releases insulin in response to glucose. With diabetes, if the tissues are insulin-resistant, insulin levels remain high due to hyperglycemia. 

Insulin prohibits lipid breakdown and results in higher blood lipid concentration because tissues are unable to uptake glucose or fat cells are unable to store lipids.

62.

Sucrose is an evidence-based pain-relieving intervention that is given to neonates for which of the following procedures?

  • All of these

  • PICC line insertion

  • Chest tube removal

  • Circumcision

Correct answer: All of these

Sucrose is considered safe and effective as an intervention for neonatal pain relief for multiple procedures, including circumcision, PICC line insertion and removal, and chest tube insertion and removal. 

Topical and/or regional medications including EMLA cream, lidocaine, as well as opioids or analgesia may also be utilized in addition to sucrose, depending on the procedure.

63.

An infant is receiving a blood transfusion. Once opened, blood bags should not be used for more than which period?

  • 4 to 6 hours 

  • 6 to 8 hours

  • 10 to 12 hours

  • 8 to 10 hours

Correct answer: 4 to 6 hours 

Blood bags should not be used for more than four hours after opening (six at the absolute most). In addition, vital signs should be obtained and recorded every 15 minutes during blood transfusions, and careful observations should be made for reactions, including increased temperature, diaphoresis, irregular respirations, bradycardia, restlessness, and pallor. If any of these findings are observed, transfusions should be stopped immediately.

64.

When is a palliative care consultation NOT indicated in the NICU?

  • When an infant is born at 24 weeks of gestational age

  • When there is a question about comfort or support

  • When there is a question about pain or symptom management specific to comfort and end-of-life

  • When an infant has a life-threatening condition or is dying despite life-sustaining interventions

Correct answer: When an infant is born at 24 weeks of gestational age

Palliative care is recommended for newborns who are born before 23 weeks of gestation. This measure would not be indicated simply because an infant is born at 24 weeks of gestational age. However, palliative care may be especially important when an infant is on the threshold of viability and is gravely ill, has an uncertain outcome, or is dying despite appropriately applied intensive care measures. 

This form of care focuses on comprehensive, compassionate comfort and support for infants and their families.

65.

Intracranial hemorrhage (ICH) is an important concern for premature neonates and is classified into four grades. Which of the following grades involves intraventricular blood? 

  • Grade II 

  • Grade I

  • Grade III

  • Grade IV

Correct answer: Grade II

Grade I hemorrhage usually has a good outcome, whereas the prognosis of grade IV hemorrhage is frequently poor. Grade I hemorrhage is confined to the germinal matrix in the caudothalamic groove. This is the last fetal germinal matrix to mature and is prone to hemorrhage in preterm babies. 

Grade II intracranial hemorrhage has intraventricular blood. Grade III hemorrhage is associated with ventricular dilation as the intraventricular clot enlarges the lateral ventricles. Grade IV hemorrhage is defined by parenchymal extension. 

66.

A nurse is caring for a term female infant who is being treated for a urinary tract infection. Ampicillin and gentamicin were started. The mother wants to know how long the infant will remain in the NICU on antibiotic therapy. 

What is the MOST appropriate response by the nurse? 

  • Antibiotic therapy will continue for 14 days, with a follow-up urine culture three days after therapy is discontinued 

  • Antibiotic therapy will continue for seven days, followed by an additional three days if a repeat culture is positive

  • Antibiotic therapy will be discontinued after three days

  • Antibiotic therapy should be discontinued after 10 days

Correct answer: Antibiotic therapy will continue for 14 days, with a follow-up urine culture three days after therapy is discontinued 

Neonatal urinary tract infections should be treated with antibiotic therapy for 10 to 14 days, with a follow-up urine culture three days after therapy is discontinued. Many practitioners recommend antibiotic prophylaxis until significant reflux or anatomic abnormality is ruled out. Traditional antibiotic coverage consists of both ampicillin and an aminoglycoside pending culture results. 

Escherichia coli is the organism most often implicated in neonatal UTIs, followed by Klebsiella. 

67.

While caring for a preterm infant who is receiving indomethacin (Indocin) for the treatment of a persistent patent ductus arteriosus (PDA), a nurse should closely monitor which of the following parameters?

  • Urine output

  • Cardiac output

  • Blood pressure

  • Liver enzymes

Correct answer: Urine output

Severely symptomatic infants do require ductal closure by either pharmacologic management or surgical ductal ligation. Indomethacin, a prostaglandin synthesis inhibitor, is the first-line therapy for the treatment of persistent PDAs: it constricts and closes the PDA in some premature infants. Ibuprofen lysine is also effective. Indomethacin decreases blood flow to the renal system, thus reducing renal perfusion and urinary output (transient oliguria). 

Urine output and creatinine levels must be closely monitored. If urine output decreases dramatically, the drug should be discontinued.

68.

An infant is born via cesarean section with a sac protruding over the lumbar region. Which of the following interventions is appropriate when providing care for this infant? 

  • Wrap the lesion with sterile gauze moistened with saline solution 

  • Place the infant in a side-lying position

  • Decrease the environmental temperature 

  • Use latex gloves 

Correct answer: Wrap the lesion with sterile gauze moistened with saline solution 

A sac on an infant's lumbar region is most likely a spinal cord malformation such as myelomeningocele or meningocele (myelomeningocele is four times more common than meningoceles). Prone positioning (not side-lying) will protect this intact dermal covering from rupture and allow continuous visualization for ongoing assessment and treatment. Wrapping the lesion with sterile gauze moistened with warm, sterile normal saline will prevent trauma and fecal contamination. Environmental temperatures should be increased to keep the infant warm. Latex precautions should be initiated because these infants have an increased propensity for developing sensitivity to latex. 

Early surgical repair is advocated as soon as possible (within 24 to 72 hours) to preserve cognitive function, improve prognosis for ambulation, and decrease mortality. 

69.

Pulmonary interstitial emphysema (PIE) results when free air is released from which structure?

  • Ruptured alveoli

  • Pleural space

  • Subcutaneous tissue

  • Connective tissue

Correct answer: Ruptured alveoli

PIE is generally a complication of mechanical ventilation and occurs when free air is released from ruptured alveoli. This free air intravasates into interstitial tissue and can compromise pulmonary vascular circulation and ventilation. Localized PIE sometimes resolves spontaneously but can frequently continue for weeks or even months. 

Subcutaneous emphysema is a collection of extraneous air in the subcutaneous tissue. Extraneous air in the pleural space is indicative of a pneumothorax.

70.

Which of the following congenital platelet function defects is characterized by large, dysfunctional platelet granules?

  • Chediak-Higashi disease

  • Glanzmann's thrombasthenia

  • Hermansky-Pudlak syndrome

  • Gray platelet syndrome

Correct answer: Chediak-Higashi disease 

Genetic platelet function defects, or congenital platelet dysfunction, cause severe bleeding in the neonatal period and are rare. Chediak-Higashi disease is an autosomal-recessive disease characterized by large, dysfunctional platelet granules and granulocytic cytoplasmic granules, with associated immunodeficiency. 

In gray platelet syndrome, the alpha granules are absent, and the platelets have a pale appearance on the peripheral smear. Glanzmann's thrombasthenia is an autosomal-recessive disorder resulting from a severe deficiency or dysfunction in the platelet fibrinogen receptor GPIIb/IIIa. Hermansky-Pudlak syndrome is a recessively inherited syndrome characterized by the absence of platelet-dense granules and oculocutaneous albinism. 

71.

A preterm infant with a diagnosis of aortic arch hypoplasia and subsequently decreased cardiac output is receiving frequent blood pressure monitoring. The nurse is asked by the physician to measure and record a four-extremity blood pressure.

Which of the following is expected in this condition?

  • A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower body

  • A diastolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower body

  • A systolic pressure that is more than 20 mm Hg higher in the right upper extremity compared with the lower body

  • A diastolic pressure that is more than 20 mm Hg higher in the right upper extremity compared with the lower body

Correct answer: A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower body

Infants at risk for decreased cardiac output should have their blood pressure evaluated frequently, as well as frequent monitoring of capillary refill and peripheral pulses. 

A blood pressure reading should be taken in both arms and both legs. A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower body is abnormal, suggesting coarctation of the aorta, aortic arch hypoplasia, or an interrupted aortic arch. 

72.

What is cryptorchidism? 

  • Undescended testes 

  • Excess fluid in the scrotum 

  • Urethral meatus failing to appear in the normal glandular position 

  • Inguinal swelling 

Correct answer: Undescended testes 

Undescended testes, or cryptorchidism, affect 1% to 4.6% of full-term males and 1.1% to 45.3% of preterm males. During the first 3 to 6 months, the testicle may spontaneously descend. The condition can be bilateral or unilateral. A urologic follow-up evaluation is recommended by 6 months of age. If a testis remains out of position at this time, surgical intervention should be undertaken to reposition the testis/testes within the scrotum. 

Excess fluid in the scrotum is a hydrocele.

Hypospadias is when the urethral meatus is present anywhere along the ventral penile surface from the glans to the perineum.

Inguinal swelling can indicate an inguinal hernia. 

73.

Advantages of bubble CPAP include which of the following?

  • The system is cost-effective, readily available, and simple.

  • The gas does not need to be heated.

  • Bubble CPAP uses the same pressure sources as ventilatory CPAP.

  • The system delivers continuous positive airway pressure at two separate CPAP levels.

Correct answer: The system is cost-effective, readily available, and simple.

As long as heaters and a gas source are available, the bubble CPAP is cost-effective, readily available, and simple to use. The system utilizes a bottle of sterile water and CPAP tubing. The level of water in which the expiratory end of the CPAP tubing is submerged determines the amount of pressure generated. As with other methods of CPAP delivery, the gas must be heated. CPAP delivers pressure continuously through both phases of breathing. Special devices offer bilevel positive airway pressure.

In ventilatory CPAP, a variable resistance in a valve is adjusted to provide resistance to the flow of air. In bubble CPAP, the positive pressure in the circuit is achieved by simply immersing the distal expiratory tubing in a water column to the desired depth rather than using a variable resistor.

74.

A nurse is caring for an infant born at 30 weeks of gestation who is in acute respiratory failure. The infant is receiving oxygen therapy and has arterial blood gases (ABGs) scheduled every six hours. This infant's arterial oxygen tension should remain in which range?

  • 60 to 80 mm Hg

  • 35 to 45 mm Hg

  • 70 to 90 mm Hg

  • 45 to 65 mm Hg

Correct answer: 60 to 80 mm Hg

In a preterm infant, optimal arterial blood gases should be maintained between:

  • PaO2: 60 to 80 mm Hg
  • PaCO2: 35 and 45 mm Hg
  • pH: 7.35 and 7.45

75.

Which of the following conditions may result in difficulty weaning an infant from mechanical ventilation? 

  • Patent ductus arteriosis (PDA) 

  • Respiratory distress syndrome (RDS) 

  • Transient tachypnea of the newborn (TTN)  

  • Meconium aspiration syndrome (MAS) 

Correct answer: Patent ductus arteriosis (PDA)

A left-to-right shunt via the PDA results in blood flow from the aorta into the pulmonary artery, thus increasing pulmonary blood flow. The increased pulmonary artery pressure and increased left ventricular pressure and volume lead to pulmonary edema and bilateral congestive heart failure (limiting the physiologic ability to wean successfully from the ventilator). 

The PDA will often present clinically in 4 to 7 days after birth with an inability to wean from the ventilator or a need for increased ventilatory and oxygen support. 

76.

A hyperoxia test is ordered for a newborn who presents with tachypnea and mild cyanosis. An arterial blood gas (ABG) is drawn from the right radial artery with the infant breathing room air, then again after the infant has been on 100% oxygen for five minutes. Their PaO2 is 180 mm Hg. 

This result indicates which of the following?

  • Respiratory distress syndrome

  • Cyanotic heart disease

  • Persistent pulmonary hypertension (PPHN)

  • Congenital heart disease (CHD)

Correct answer: Respiratory distress syndrome 

A hyperoxia test is beneficial in differentiating respiratory disease from cyanotic heart disease. This test is a sensitive and specific tool in the initial evaluation of a neonate with suspected CHD and is used to investigate the possibility of a fixed right-to-left shunt. A right-to-left shunt is demonstrated if a patient's PO2 does not increase in 100% oxygen. 

Blood gas measurements are obtained (preferably from the right radial artery) when the infant is breathing room air and then after the infant has been in 100% oxygen for 5 to 10 minutes. A significant increase in PaO2 levels, particularly a PaO2 of >150 mm Hg, makes respiratory distress more likely rather than cardiac in origin (the presence of a right-to-left shunt and CHD as the cause of cyanosis is unlikely). 

Levels below 50 to 60 mm Hg may be related to the transposition of the great vessels or from defects in pulmonary outflow. Infants with PPHN commonly present with hypoxia and hypoxemia.

77.

A pregnant woman has a shortened cervix and is experiencing significant contractions. She is admitted to the labor and delivery unit and given a dose of prophylactic antenatal steroids to decrease the risk of respiratory distress syndrome (RDS) in her infant. Fortunately, her labor was halted with the use of tocolytics. Three weeks later, her membranes rupture, and delivery is imminent.

The American College of Obstetricians and Gynecologists (ACOG) recommends a repeat course of antenatal steroids if the fetus is younger than:

  • 34 weeks of gestation

  • 36 weeks of gestation

  • 32 weeks of gestation

  • 37 weeks of gestation

Correct answer: 34 weeks of gestation

Antenatal corticosteroid treatment of women at risk for preterm delivery between 24 and 34 weeks of gestation has been shown to be effective and safe in enhancing fetal lung maturity and reducing neonatal mortality. 

The ACOG recommends a repeat course of antenatal steroids if the fetus is younger than 34 weeks of gestation and the previous course of antenatal steroids was administered more than 14 days earlier.

78.

The respiratory rate in high-frequency ventilation (HFV) is determined by the Hertz setting. What does one Hertz represent?

  • 60 breaths per minute

  • 30 breaths per minute

  • 90 breaths per minute

  • 100 breaths per minute

Correct answer: 60 breaths per minute

One Hertz represents 60 breaths per minute. Therefore, 10 Hertz equals 600 breaths/minute. The rate is initially set between 10 and 15 Hz. Hertz indicates the rate at which fresh gases are delivered to the lungs.

79.

All the following are helpful, professional interventions for families dealing with neonatal illness or loss, EXCEPT:

  • Distraction

  • Emotional support

  • Grief education

  • Attention to the parent(s) and baby

Correct answer: Distraction

For professionals, understanding parental perspectives of the experience of a critically ill newborn or infant death should foster more sensitive and evidence-based care for grieving families. Families value emotional support, grief education, and attention to the parent(s) and baby.

Nonhelpful and distressing interventions from health care providers included avoidance, thoughtlessness, insensitivity, poor staff communication, and distraction. Professionals may try to distract parents from feelings of acute grief by engaging in light, social conversation. However, parents are preoccupied with their loss and are not typically interested in distractions.

80.

When a nurse is assisting with neonatal endotracheal (ET) intubation, a portable bedside chest x-ray reveals the ET tube is inserted too far into the infant's chest. Where is the tube most likely located in this scenario? 

  • Right mainstream bronchus 

  • Left mainstream bronchus 

  • Right upper lobe 

  • Left upper lobe 

Correct answer: Right mainstream bronchus 

The right mainstream bronchus is at a 25-degree angle from the trachea versus the left mainstream bronchus (which is at a 45-degree angulation). This results in easier intubation of the right mainstream when the ET tube is inserted too far. 

Auscultation of breath sounds in this scenario will reveal louder breath sounds on the right and no fogging or condensation in the ETT on exhalation. 

×