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Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 5 of 25

81.

When considering the use of a translator for an infant's parents who do not speak English, which of the following considerations is of the HIGHEST importance?

  • The interpreter must have training in medical vocabulary for both languages

  • The interpreter must speak both languages well

  • The interpreter must be available on-site

  • The interpreter must know the patient's history

Correct answer: The interpreter must have training in medical vocabulary for both languages

The interpreter should have training in medical vocabulary for both languages. Just speaking the languages well does not mean that the interpreter will adequately translate medical information and terminology.

It is not necessary for the interpreter to know the patient's history, as their job is only to interpret what is said, not add to or filter it based on prior knowledge. While on-site interpreters are ideal, translation can be done via phone.

82.

A male infant was born at 28 weeks of gestation via cesarean section. Immediately following delivery, the infant developed respiratory distress and required supplemental oxygen therapy and mechanical ventilation. His chest x-ray shows a reduction in lung volume and expansion with diffuse atelectasis.

What is the MOST likely cause of his respiratory distress?

  • Surfactant deficiency

  • Transient tachypnea of the newborn

  • Pulmonary hypertension

  • Bronchopulmonary dysplasia

Correct answer: Surfactant deficiency

Chest x-ray findings in an infant with surfactant-deficient respiratory distress syndrome include diffuse atelectasis, a reduction in lung volume, and decreased lung expansion. 

Atelectasis increases lung density and results in visible outlines of air-filled bronchi against opaque lung tissue. Chest x-ray results also have a ground-glass appearance that represents areas of atelectatic respiratory alveoli adjacent to expanded or hyperexpanded respiratory units.

83.

Which organism is MOST often responsible for causing neonatal urinary tract infections (UTIs)? 

  • Escherichia coli 

  • Klebsiella 

  • Enterobacter

  • Citrobacter 

Correct answer: Escherichia coli 

UTIs in newborns are frequently associated with bacteremia and can result in long-term complications. Newborns with UTI should be evaluated for associated systemic infection and anatomic or functional abnormalities of the urinary tract (causing many UTIs in neonates). Escherichia coli is most often implicated in neonatal UTIs, accounting for up to 80% of cases, followed by Klebsiella. 

Enterobacter and Citrobacter are less common causes of neonatal UTIs. 

84.

A nurse is caring for a term infant who was just admitted to the NICU with tachypnea, tachycardia, cyanosis, lethargy, hypotonia, and poor feeding due to a poor suck. The infant is ruddy in appearance and seizes shortly after admission to the NICU.

What is the MOST likely diagnosis?

  • Hyperviscosity

  • Hyperbilirubinemia

  • ABO incompatibility

  • Physiologic anemia

Correct answer: Hyperviscosity 

Hyperviscosity is a syndrome of circulatory impairment resulting from increased resistance to blood flow. Complications include respiratory distress, congestive heart failure, neurologic signs, and sequelae such as significant motor and mental disability and cerebral palsy. 

Newborn infants with hematocrit values of greater than 65% to 70% may manifest symptoms of increased viscosity. Cyanosis, lethargy, irritability, hypotonia, tremor, seizures, and poor suck may be present. In addition, tachypnea, tachycardia, a ruddy appearance, and respiratory distress are common findings. Impaired GI function often develops with abdominal distention, decreased bowel function, and poor feeding.

85.

Which of the following factors does NOT contribute to the development of necrotizing enterocolitis (NEC) in a preterm infant? 

  • Decreased gastric pH

  • Immature intestinal barrier

  • Bacterial colonization of the gut 

  • Intestinal ischemia 

Correct answer: Decreased gastric pH

NEC is an inflammatory condition of the bowel that affects primarily preterm infants (although approximately 5% of cases occur in term babies). NEC is fatal in 17% of all cases, 20% of very-low-birth-weight infants who develop the disease, and up to 40% to 50% in infants with a birth weight below 1,000 g. The etiology is unknown but may be multifactorial. Several mechanisms have been suggested:

  • perinatal stressors 
  • an immature intestinal barrier 
  • intestinal ischemia 
  • bacterial colonization of the gut 
  • alteration of the intestinal microbiome (intestinal dysbiosis) 
  • nutritional substrate in the gut lumen 

Decreased gastric pH is implicated in gastroesophageal reflux, not NEC. 

86.

Determination of alpha-fetoprotein (AFP) levels in amniotic fluid and maternal serum allows the identification of which condition?

  • Open myelomeningoceles

  • Craniosynostosis

  • Hydrocephalus

  • Cerebellar malformations

Correct answer: Open myelomeningoceles 

Any defect in which the spinal or cranial contents are "open" to the outside, such as myelomeningocele or encephalocele, is associated with an elevation of alpha-fetoprotein (AFP) in the amniotic fluid. This is important for a prenatal diagnosis. 

Testing maternal serum for AFP is also an option. At some centers, it may be used along with ultrasonography or fetal MRI for diagnosis, allowing amniocentesis to be omitted.

87.

Infants requiring prolonged hospitalization in the NICU are at risk of developing pneumonia due to which of the following?

  • Nosocomially acquired organisms

  • Proximity to other ill infants

  • Frequent handling by various healthcare professionals and family members

  • Prolonged ventilator use

Correct answer: Nosocomially acquired organisms 

Neonates requiring prolonged hospitalization in the NICU can develop pneumonia from nosocomially acquired organisms. The causative organisms are mainly group B streptococci and gram-negative organisms (e.g., E. coli, Klebsiella, Pseudomonas) but also include Staphylococcus aureus, Streptococcus pneumoniae, and Candida.

Although the other choices do put infants at risk of acquiring pneumonia, nosocomially acquired organisms are the greatest risk factor for infants with prolonged NICU stays.

88.

For women with a previous neural tube defect (NTD) pregnancy, what is the recommended dose of folic acid? 

  • 4 mg daily

  • 400 mcg daily

  • 1,000 mcg daily

  • 2 mg daily

Correct answer: 4 mg daily 

The major environmental factor linked to NTDs is the dietary level of folic acid. All women of childbearing age should consume 400 mcg (0.4 mg) of folic acid daily, even when not planning to become pregnant. However, women at increased risk, including those with a previous NTD pregnancy, should consume 4 mg (4,000 mcg) of folic acid daily. It should be taken at least one month before conception.

89.

What term is characterized by fair treatment without discrimination?

  • Justice

  • Veracity

  • Fidelity

  • Autonomy

Correct answer: Justice

Justice is defined as fair treatment without discrimination. It focuses on the fair distribution of the benefits, risks, and costs among members of society in relation to healthcare needs. 

Veracity is best described as being truthful, being honest, and having integrity. Fidelity is an obligation to care to the best of one's ability and to keep one's promises. Autonomy is self-determination and freedom of choice.

90.

Which of the following conditions usually presents with non-blanchable petechiae in a neonate?

  • Thrombocytopenia

  • Early hemorrhagic disease of the newborn

  • Hemophilia

  • Hemangioma

Correct answer: Thrombocytopenia 

Thrombocytopenia is a general term that denotes a decreased number of platelets in an infant's blood. It is the most common coagulation disorder in neonates. Thrombocytopenia generally manifests with small, flat hemorrhages in the skin called petechiae that do not blanch with pressure. 

Early hemorrhagic disease of the newborn presents within the first 24 hours after birth with skin bruising, massive cephalohematoma, GI tract bleeding, or intracranial hemorrhage. Hemophilia may or may not manifest immediately after birth. Intracranial hemorrhage has been documented in approximately 1% to 4% of infants with hemophilia as a result of birth trauma. In addition, approximately 50% of male infants will hemorrhage from a circumcision. Prolonged bleeding from the umbilical cord stump also suggests hemophilia. A hemangioma is a dark red raised lesion that blanches with pressure.

91.

Which principle, often viewed within the larger context of nonmaleficence, claims an act of having a harmful effect is not always morally prohibited?

  • Double effect

  • Moral dilemma

  • Nonbeneficial treatment

  • Best interest

Correct answer: Double effect 

The principle of double effect asserts that an action may be considered good if the intent of the action is a positive value, even if the secondary effects of the action could be considered harmful if undertaken as the primary goal. The good effect should be commensurate with the harm. 

This principle is frequently used in NICUs. An example would be giving morphine to a dying infant to reduce pain and suffering, even though it can cause bradycardia and apnea.

92.

What is the main focus of the research standard of the American Association of Critical-Care Nurses (AACN) professional performance?

  • Evidence-based practice

  • Bench research

  • Survey research

  • Government-funded research grants

Correct answer: Evidence-based practice 

The AACN helps establish quality standards for nursing education, assists schools in implementing those standards, influences the nursing profession to improve health care, and promotes public support for professional nursing education, research, and practice. 

Evidence-based practice (EBP) is the main focus of the research standard of AACN professional performance. EBP is a systematic way to integrate the best patient-centered, clinically relevant research with clinical expertise and the unique preferences, concerns, and expectations of each patient.

93.

Screening of pregnant women for group B streptococcus (GBS) is recommended at which time?

  • 35 to 37 weeks of gestation

  • 26 to 28 weeks of gestation

  • 30 to 32 weeks of gestation

  • 32 to 34 weeks of gestation

Correct answer: 35 to 37 weeks of gestation

The ACOG Committee on Obstetric Practice now recommends "universal vaginal or rectal group B streptococci screening of pregnant women" at 35 to 37 weeks of gestation and the use of intrapartum prophylactic IV antibiotics in GBS positive women to prevent transmission to infants during delivery. 

Treatment for women with a positive culture, GBS bacteriuria during the current pregnancy, or a previously GBS-infected infant is usually penicillin. 

94.

A nurse is caring for a preterm infant with respiratory distress syndrome who is receiving bubble continuous positive airway pressure (CPAP). All the following are recommended nursing interventions EXCEPT:

  • Continuous monitoring of alarms indicating a leak in the system

  • Frequent emptying of the exhalation tube

  • Continuous monitoring of pressure at the nasal airway interface

  • Using an adjustable pressure-relief valve in the circuit

Correct answer: Continuous monitoring of alarms indicating a leak in the system

Bubble CPAP is a non-invasive ventilation strategy for newborns with respiratory distress syndrome (RDS). It is one of the methods by which CPAP is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. Condensation in the exhalation limb of a patient circuit during bubble CPAP accumulates at a rate of 3.8 mL/hr. When this condensation reaches volumes above 10 mL, the oscillating fluid increases airway pressure and results in increases in mean tracheal pressure. Frequent emptying (every 2-3 hours) of the exhalation tube, continuous monitoring of pressure at the nasal airway surface, and using an adjustable pressure-relief valve in the circuit (set to 5 cm H2O pressure above the desired mean pressure) are all recommended interventions when caring for an infant receiving bubble CPAP therapy.

The bubble system has no audible alarms to indicate a leak in the system; instead, the nurse would notice a cessation of bubbling in the underwater chamber.

95.

Which of the following statements is TRUE regarding premature infants?

  • A premature infant has a more compliant chest cage and less compliant lungs, resulting in a greater respiratory workload.

  • A premature infant has a less compliant chest cage and less compliant lungs, resulting in a greater respiratory workload.

  • A premature infant has a less compliant chest cage and more compliant lungs, resulting in a greater respiratory workload.

  • A premature infant has a more compliant chest cage and more compliant lungs, resulting in a greater respiratory workload.

Correct answer: A premature infant has a more compliant chest cage and less compliant lungs, resulting in greater respiratory workload.

Because a premature infant has a more compliant chest cage and less compliant lungs, a greater respiratory workload ensues. Respiratory muscle fatigue occurs easily in the absence of fatigue-resistant fibers.

96.

The most common pain behaviors in neonates include all the following, EXCEPT: 

  • Oxygen saturation

  • Crying

  • Changes in arousal state

  • Facial grimacing

Correct answer: Oxygen saturation

Expression of pain through behavior is often an infant's only means of communicating pain. Crying, changes in arousal state, and facial grimacing are the most robust pain behaviors in neonates experiencing pain.

Although physiologic changes such as (decreased) oxygen saturation may be present with pain, it is not the most specific and reliable indicator of neonatal pain.

97.

A nurse is assessing a two-day-old infant in the newborn nursery and palpates an abdominal mass. Which of the following is the MOST likely cause of the newborn's mass?

  • Hydronephrosis

  • Wilms' tumor

  • Renal vein thrombosis

  • Nephroblastomatosis

Correct answer: Hydronephrosis 

Hydronephrosis, the most common cause of abdominal mass in the newborn, involves dilation of the pelvis and calyces, most often as a result of congenital obstruction. If it is unilateral, urine output may not be significantly reduced, and the identification of the abdominal mass may be the first indicator of disease. A nuclear renal scan is helpful to diagnose both ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstruction. 

While the other choices are all types of neonatal abdominal masses, they are not as common as hydronephrosis.

98.

An infant exposed to which of the following drugs in utero would MOST likely have more severe neonatal abstinence syndrome (NAS) symptoms?

  • Opioids

  • Amphetamines

  • Marijuana

  • Nicotine

Correct answer: Opioids 

NAS symptoms are most commonly observed in the opioid-exposed neonate. A scoring system is utilized to monitor an infant comprehensively and objectively. Signs and symptoms of drug withdrawal are recorded in varying degrees of severity. 

Each symptom is assigned a score. Higher scores indicate symptoms found in infants with more severe withdrawal. Overall, opioid-exposed infants have more severe NAS symptoms.

99.

A nurse encounters a language barrier with a family of an infant who is receiving NICU care. All the following interventions are needed, EXCEPT: 

  • Using "yes" or "no" questions when communicating with the family

  • Using a bilingual interpreter

  • Using pictures to augment what is being explained

  • Providing a list of common medical terms in the family's preferred language

Correct answer: Using "yes" or "no" questions when communicating with the family 

If a language barrier is encountered, a qualified interpreter who is bilingual and bicultural should be used. Interpreters should be familiar with medical terminology and information. Also, consider using pictures to augment explanations and providing a list of common medical terms and educational materials in the family's preferred language. 

Using "yes" or "no" questions is ineffective and inappropriate when communicating with a family when a language barrier exists.

100.

Which of the following adjunct therapies for hypoglycemia in a neonate works by inhibiting insulin secretion?

  • Diazoxide (Proglycem)

  • Corticosteroids

  • Glucagon

  • Somatostatin

Correct answer: Diazoxide (Proglycem)

Diazoxide inhibits or suppresses pancreatic insulin secretion, thus aiding in the treatment of neonatal hypoglycemia. Its use is reserved for situations of profound hyperinsulinemia that have failed other therapies.

Corticosteroids work by decreasing peripheral glucose utilization and enhancing gluconeogenesis. Glucagon stimulates glycogenolysis. Somatostatin inhibits insulin and growth hormone release. 

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