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Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 6 of 25

101.

Which of the following sets of chest x-ray findings indicates neonatal pneumonia caused by group B beta-hemolytic streptococci (GBS)?

  • Diffuse reticulogranular pattern, opacity, patchy infiltrates, pleural effusion

  • Perihilar infiltrates; streaky, lobar consolidation; late-onset pleural effusion

  • Bilateral consolidation, lung abscess, pneumatocele

  • Diffuse infiltrates, abscess formation

Correct answer: Diffuse reticulogranular pattern, opacity, patchy infiltrates, pleural effusion

Neonatal pneumonia that is caused by GBS will show a diffuse reticulogranular pattern, opacity ("whiteout"), patchy infiltrates, and pleural effusion on a neonate's chest x-ray.

Perihilar infiltrates; streaky, lobar consolidation; and late-onset pleural effusion on an x-ray are all indicative of pneumonia caused by herpes virus. Pneumonia caused by Klebsiella bacteria will show bilateral consolidation, lung abscess, and pneumatocele on a chest x-ray. Diffuse infiltrates and abscess formation on a chest x-ray are indicative of neonatal pneumonia caused by MRSA (methicillin-resistant Staphylococcus aureus).

102.

All of the following may be used in the treatment of TTN (transient tachypnea of the newborn), EXCEPT:

  • Diuretic agents to eliminate excess lung fluid

  • CPAP

  • Antibiotic therapy with risk factors for infection 

  • Mechanical ventilation

Correct answer: Diuretic agents to eliminate excess lung fluid

In general, support of an infant with TTN requires only sufficient supplemental oxygen to maintain an arterial oxygenation tension of more than 70 to 80 mm Hg and usual supportive neonatal care. Frequently, little more than general support is necessary while the normal absorption of lung fluid through the lymphatic system occurs. As the lung fluid clears, both the x-ray abnormalities and the clinical presentation of the infant resolve within 72 hours. Nasal CPAP or mechanical ventilation is generally well tolerated and effective. 

Although diuretic agents have been advocated, a recent systematic review found no benefit and recommended against the use of oral or intravenous furosemide for the treatment of TTN. Empiric antibiotics are warranted only for infants with TTN who have risk factors for infection.

103.

A subarachnoid hemorrhage (SAH), the most common type of neonatal intracranial hemorrhage, is characterized by which of the following?

  • Bleeding into the cerebrospinal fluid (CSF)-filled space between the arachnoid membrane and the pia mater

  • Bleeding from a tear of arterial origin

  • Bleeding secondary to an extension of a subdural hemorrhage

  • Bleeding between the dura mater and the skull that is accompanied by a linear skull fracture across the middle meningeal artery

Correct answer: Bleeding into the cerebrospinal fluid (CSF)-filled space between the arachnoid membrane and the pia mater  

The most common type of neonatal intracranial hemorrhage, a subarachnoid hemorrhage, involves bleeding within the subarachnoid space (the space between the arachnoid and pial membranes) but not because of extension from other areas. Small hemorrhages are more common than large ones, and the origin is believed to be small vascular (not arterial) channels. This type of hemorrhage is usually caused by trauma for term infants and hypoxia for preterm infants. 

A subdural hemorrhage is bleeding that occurs between the dura mater and the skull that is accompanied by a linear skull fracture across the middle meningeal artery; it generally occurs from birth trauma tearing the veins and venous sinuses.

104.

Which of the following is an example of family-centered care (FCC) in the NICU?

  • A personal connection and a relationship with their infant's healthcare providers

  • Limiting parental involvement in healthcare decisions

  • Communication with the parents only when they are at the bedside

  • Reminding parents of visiting hours and strictly adhering to them 

Correct answer: A personal connection and a relationship with their infant's healthcare providers

FCC is a philosophy that is key in the NICU; it is a concept that involves NICU staff accepting families' involvement in infant care. FCC principles stress that parents are the most important persons in their infant's life and that their values and beliefs should be the primary focus during NICU care.

The FCC philosophy challenges healthcare providers to shift their care from task-oriented, provider-centered to a collaborative, relationship-based model of family advocacy and empowerment. Thus, limiting parental involvement, communicating with parents only when at the bedside, and not allowing parents ample time with their infants are all hindrances to FCC. Families want a personal connection and a relationship with healthcare providers. 

105.

Syndactyly is a common congenital malformation that is characterized by webbed or conjoined fingers or toes. At what gestational age does this condition occur? 

  • 6 weeks

  • 12 weeks 

  • 18 weeks 

  • 24 weeks 

Correct answer: 6 weeks

Syndactyly (of the fingers or toes) generally occurs between the 6th and 8th weeks of fetal development when the digits fail to separate. This is a common congenital malformation. 

106.

The immature/total neutrophil (I/T) ratio is used as a negative predictor value. If a patient's I/T ratio is normal, their likelihood of infection is negligible with a 99% predictive value. However, if the I/T ratio is abnormal, it suggests infection. 

For an infection to be suspected, a patient's I/T ratio must be greater than which value?

  • 0.2 to 0.25

  • 0.5 to 0.75

  • 0.1 to 0.2

  • 0.75 to 1

Correct answer: 0.2 to 0.25

An increased I/T ratio is known as a shift to the left, reflecting an increase in immature neutrophils. This is not a consistent correlation with the presence of a serious infection. Low immature band counts may be due to depleted bone marrow reserves producing misleading low I/T ratios. Thus, this tool serves best as a negative predictor value. 

However, if the I/T ratio is greater than 0.2 to 0.25, it is suggestive of infection. The calculation of an I/T ratio is: 

% Bands + % Immature forms / % Mature + % Bands + % Immature forms 

107.

An infant delivered at 36 weeks of gestation via cesarean section secondary to maternal preeclampsia is exhibiting signs of magnesium toxicity at 12 hours after birth. Which of the following signs does NOT indicate neonatal toxicity from maternal magnesium administration?

  • Increased serum calcium

  • Hypotonia 

  • Lethargy

  • Poor feeding 

Correct answer: Increased serum calcium levels 

Magnesium sulfate is utilized to prevent maternal seizures and can cause respiratory and neuromuscular depression in neonates for 24 to 48 hours following delivery. Neonatal consequences of maternal magnesium administration include decreased muscle tone (hypotonia) and drowsiness, poor suck and ineffective feedings, and decreased serum calcium. 

108.

A social worker has been consulted on an infant who is nearing discharge after the parents informed the nurse that they do not have a car seat. When questioned further, the parents admit not being able to afford one. 

What is the BEST action by the social worker? 

  • Provide the parents with an approved car seat and discuss any further aid they may need beyond the hospital stay 

  • Refer the parents to a local community resource to obtain a car seat 

  • Report to the charge nurse that discharge may be delayed due to the lack of a car seat 

  • Offer to give the family a car seat to use personally 

Correct answer: Provide the parents with an approved car seat and discuss any further aid they may need beyond the hospital stay 

Utilizing an interdisciplinary resource (social work) that can address multiple needs of a patient exemplifies systems thinking. This holistic approach takes into consideration what aid the family may need beyond the hospital stay (in addition to providing a car seat prior to hospital discharge). 

109.

For diazepam overdose in a neonate, flumazenil (Mazicon) is administered to reverse the effects of the benzodiazepine. What is the usual intravenous push dose of flumazenil?

  • 10 mcg/kg

  • 5 mcg/kg

  • 10 mg/kg

  • 5 mg/kg

Correct answer: 10 mcg/kg

For a benzodiazepine overdose (e.g., midazolam, diazepam, lorazepam), the correct intravenous push dose of flumazenil (reversal agent) is 10 mcg/kg given over 15 seconds. The infant must be closely monitored for seizure activity. 

A patent IV is vital to prevent local pain and irritation after administration.

110.

The signs and symptoms of an inborn error of metabolism in a neonate are MOST likely to be mistaken for which other neonatal condition?

  • Sepsis

  • Respiratory distress syndrome (RDS)

  • Intestinal obstruction

  • Congenital heart defect

Correct answer: Sepsis

Signs and symptoms of inborn errors of metabolism are often nonspecific and can mimic those of sepsis. 

Clinical evidence of a congenital heart defect differs from the signs and symptoms of inborn errors of metabolism. 

Clinical manifestations of intestinal obstruction can include nonspecific findings but also specifically relate to the gastrointestinal tract and abdomen, whereas inborn errors of metabolism do not. 

The signs and symptoms of RDS are fairly specific and respond to specific treatments, unlike those of most inborn errors of metabolism. 

111.

Which of the following exemplifies neonatal heat loss via CONVECTION in the delivery room? 

  • Placing the infant next to a cold draft 

  • Placing the infant on a cold scale 

  • Placing the infant on a wet blanket with amniotic fluid still covering the skin 

  • Placing the infant in an isolette with cold walls next to cold windows 

Correct answer: Placing the infant next to a cold draft 

Convection is the loss of heat to moving air at the surface of the skin and depends on the air's velocity and temperature. In this manner, heat loss will occur when an infant is exposed to cool air (e.g., air conditioning) or if they are placed into an incubator that has not been prewarmed. 

Heat loss via conduction (transfer of heat via direct contact) occurs when an infant is placed on a cold surface (e.g., a scale). 

Evaporation is heat transfer due to water vaporizing from the skin or respiratory tract; this can be easily avoided in the delivery room by immediately drying and wrapping the infant in a warm blanket (or placing skin-to-skin with mom, with a warm blanket covering the infant).  

Radiation is the transfer of heat from a warmer object to a cooler object that is not in direct contact through infrared energy transfer. Placing the infant in an isolette with cold walls next to cold windows is an example of heat loss via radiation. This example would be remedied by placing the infant in a double-walled isolette away from cold windows. 

112.

In the event of perinatal asphyxia (oxygen deprivation during the birthing process), which organ is MOST commonly affected in neonates? 

  • Kidney

  • Brain

  • Liver

  • Lungs

Correct answer: Kidney

Perinatal asphyxia is associated with intrinsic renal failure (due to poor renal perfusion) in approximately 40% of affected term neonates. This condition can manifest as either oliguria (decreased urine output) or nonoliguric renal failure. 

The kidney is the most common organ to be affected by perinatal asphyxia (e.g., due placental abruption, cord rupture, maternal hemorrhage). 

113.

Folic acid prevents neural tube defects (NTDs), such as encephaloceles and myelomeningoceles. What is the current recommendation for folic acid supplementation for healthy pregnant women?

  • 400 to 800 mcg daily 

  • 4000 mcg daily

  • 200 to 400 mcg daily

  • 1,000 mcg daily 

Correct answer: 400 to 800 mcg daily 

The current recommendation for folic acid supplementation is 400 to 800 mcg of folic acid daily for all women planning to or capable of becoming pregnant. Supplementation should begin at least 1 month before pregnancy and continue until 12 weeks of gestation. 

Women at high risk for pregnancy with an NTD should take 4 mg (4,000 mcg) of folic acid daily. 

114.

Which of the following cerebrospinal fluid (CSF) values in a premature infant is abnormal and could indicate meningitis?

  • CSF glucose level of 30 mg/dL

  • CSF protein level of 125 mg/dL

  • CSF white blood cell count of 80/mm3

  • CSF leukocyte count of 25/mm3

Correct answer: CSF glucose level of 30 mg/dL

CSF is examined in most infants with suspected sepsis because meningitis is difficult to rule out without a lumbar puncture, and its diagnosis affects therapy and follow-up in an infant. A CSF glucose level of 30 mg/dL is abnormal and could indicate sepsis and meningitis.

Normal ranges of CSF glucose in preterm infants are 64-106 mg/dL with reported mean values of 79-83 mg/dL. Normal ranges of CSF protein levels in preterm infants are 31-292 mg/dL with reported mean values of 75-150 mg/dL. Normal ranges of CSF white blood cell (leukocyte) counts in preterm infants are 0-112/mm3 with reported mean ranges of 2-27/mm3.

115.

Which branch of ethics seeks to determine the most morally desirable course of action arising from problems in medical and biological research and clinical practice?

  • Bioethics

  • Virtue ethics

  • Narrative ethics

  • Case-based ethics

Correct answer: Bioethics

Bioethics is the study of typically controversial ethical issues emerging from situations and possibilities brought about by advances in biology and medicine. It also involves moral discernment as it relates to medical policy and practice.

Case-based ethics, narrative ethics, and virtue ethics are theories of ethics.

116.

What is an appropriate nursing intervention for an infant requiring supplemental oxygen via an oxygen hood?

  • Use a blender system to administer a fixed oxygen concentration

  • Implement no intervention

  • Switch the infant to a nasal cannula to ensure appropriate development of social and motor skills

  • Obtain an order and change the infant to nasal continuous positive airway pressure (CPAP)

Correct answer: Use a blender system to administer a fixed oxygen concentration

An oxygen hood fits over the infant's head to deliver a constant concentration of oxygen and is appropriate for cases of mild respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration, or pneumonia. A blender system is the most reliable way to administer a fixed oxygen concentration via a hood. Another source of oxygen must be provided when the infant's head is removed from the hood because of feeding, holding, or suctioning. 

A nasal cannula is used for the dependent infant who is developing social and motor skills, particularly when being discharged home on supplemental oxygen. Nasal CPAP is not warranted if the infant demonstrates sufficient ventilation to maintain a normal PaCO2 value, as in the case of an infant requiring only an oxygen hood.

117.

A former 28-week-gestation infant is scheduled for a six-month NICU follow-up appointment. What is the infant's "corrected age" that the practitioner will use when assessing their developmental status? 

  • Three months

  • Four months

  • Five months

  • Two months

Correct answer: Three months

Corrected age accounts for an infant's prematurity. It is sometimes referred to as “adjusted age" or "post-conceptual age" and is calculated by starting with the chronological (or actual) age and subtracting the number of weeks of prematurity from that age. 

The formula is: (Chronological Age) - (Weeks or months of prematurity) = Corrected age

Thus, if an infant was born at a gestational age of 28 weeks, they are 12 weeks premature, as a term pregnancy is 40 weeks. If the infant's actual age is six months, then their corrected age would be three months.

118.

To decrease the risk of contracting toxoplasmosis, a pregnant woman should avoid all the following, EXCEPT: 

  • Consuming pasteurized milk

  • Exposure to raw or undercooked meats

  • Cat feces

  • Eating fruits or vegetables not peeled or washed thoroughly

Correct answer: Consuming pasteurized milk 

Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii, which is present in many warm-blooded animals but has only been found to reproduce in the guts of cats. Therefore, women should avoid unnecessary exposure to cat feces. Using gloves and wearing a mask when emptying the litter box can protect pregnant women if they must empty a litter box.

In addition, eating meat that is not fully cooked increases the risk of exposure since pork, beef, and lamb are most likely to carry this parasite. Washing fruits and vegetables thoroughly before eating them decreases the risk of infection. Even when peeling fruits or vegetables, they should still be rinsed. When a knife is used to cut them, the parasite is simply pushed further into the fruit or vegetable. After washing, they should be dried with a paper towel or clean dish towel to remove some bacteria and parasites.

Finally, a pregnant woman (or any woman attempting to become pregnant) should use hot, soapy water to wash her hands immediately after exposure to any infectious source, even after wearing gloves. 

Pregnant women should only consume pasteurized milk (and avoid raw milk), as raw milk can carry toxoplasmosis.

119.

Which of the following nursing interventions would be appropriate for an infant with myelomeningocele?

  • Place the infant in a prone position, cover them with warm saline-soaked gauze, and avoid fecal contamination

  • Place the infant in a supine position to reduce the cyst

  • Keep the infant in a prone position

  • Maintain the infant in a side-lying position with support aids around the site, keep the area open to the air, and avoid fecal contamination

Correct answer: Place the infant in a prone position, cover them with warm saline-soaked gauze, and avoid fecal contamination

Myelomeningocele is generally surgically repaired as soon as possible (within 24 to 72 hours). Prevention of infection is paramount in caring for these infants. Trauma to the area should be avoided by keeping the infant in the prone position and maintaining sterile gauze moistened with warm, sterile normal saline. Tape should be avoided at all costs. 

Preventing fecal contamination is vital. In addition, latex precautions should be initiated because these infants have an increased propensity for developing latex sensitivity.

120.

Informed consent for human research involves all the following, EXCEPT: 

  • Full disclosure of study risks after someone participates

  • Complete explanation of study purpose and procedures 

  • Accurate description of potential benefits to self and/or society 

  • Permission for use of medical records 

Correct answer: Full disclosure of study risks after someone participates

Elements of informed consent for human research include a thorough explanation of the study purpose and procedures, full disclosure of study risks, a description of potential adverse effects and how they will be treated, and an accurate description of potential benefits to self and/or study BEFORE the procedure begins (not after). 

Permission for the use of medical records is also an element of informed consent. 

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