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Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 7 of 25

121.

When considering weaning an infant from the ventilator, which of the following parameters indicates improvement, thus supporting ventilatory weaning and extubation?

  • Supplemental oxygen ranging between 21% and 30%

  • Tidal volume values below 6 mL/kg

  • Progressively increasing FiO2 requirements 

  • Peak inspiratory pressure of 18 to 22 cm H2O

Correct answer: Supplemental oxygen ranging between 21% and 30%

When ventilatory parameters are low, weaning an infant from the ventilator should be considered. Supplemental oxygen requirements ranging between 21% and 30% are indicative of improvement, and weaning would be indicated. 

Tidal volume values above 6 mL/kg, increased activity and muscle tone in addition to progressively decreasing (not increasing) FiO2 requirements, and peak inspiratory pressures of 16 to 18 cm H2O all indicate an improving infant.

122.

Which of the following sets of findings comprise the acronym "HELLP" in HELLP syndrome?

  • Hemolysis, elevated liver enzymes, and low platelets

  • Hypertension, elevated liver enzymes, and low platelets

  • Hemophilia, elevated liver enzymes, and low platelets

  • Hemoptysis, elevated liver enzymes, and low platelets

Correct answer: Hemolysis, elevated liver enzymes, low platelets

HELLP syndrome, a severe form of pregnancy-induced hypertension, is manifested by hemolysis, elevated liver enzymes, low platelets, and renal function abnormalities, and carries a high risk of fetal and maternal death. 

For milder cases of HELLP syndrome, conservative management may facilitate improvement before delivery, but the risk of intrauterine growth restriction (IUGR) remains. Immediate delivery is necessary in many cases of HELLP syndrome, regardless of the gestational age of the fetus.

123.

Evaluation of postpartum depression (PPD) is indicated for women who exhibit symptoms of postpartum blues beyond which period?

  • Two weeks postpartum

  • Six weeks postpartum

  • Four weeks postpartum

  • Eight weeks postpartum

Correct answer: Two weeks postpartum

Postpartum blues, often referred to as baby blues, affects up to 80% of new mothers. Symptoms such as mood swings, sleep and appetite disturbances, anxiety, irritability, and crying are often interspersed with times of feeling well. The baby blues is a time-limited condition and often relatively benign. 

However, if these symptoms persist beyond 2 weeks postpartum, further evaluation is needed. Approximately 20% of women develop PPD. Assessment tools, such as the Edinburgh Postnatal Depression Scale (EPDS), are generally implemented on days two to three postpartum to identify women at risk for PPD. 

124.

Which of the following 12-lead ECG findings is NOT indicative of a normal sinus rhythm in a healthy full-term 3-day-old neonate? 

  • Narrow QRS complex with a fixed and regular R-R interval

  • Regular rhythm with a ventricular rate of approximately 120 beats/minute 

  • P-wave with constant morphology preceding every QRS complex 

  • Positive P-wave in leads I, II, and aVF

Correct answer: Narrow QRS complex with a fixed and regular R-R interval

A normal sinus rhythm (NSR) is defined as three consecutive beats with identical waveforms on an ECG. The waveform similarities indicate that the origin of the impulse is the same. NSR is defined by the following criteria:

  • a regular rhythm with a ventricular rate within an age-specific normal interval (during the first week post birth, the heart rate is approximately 120 beats/min)
  • a P-wave with constant morphology preceding every QRS complex
  • a P-wave that is positive in lead II (and also I and aVF)

A fixed and regular R-R interval with narrow-complex QRS complexes and absent P-waves can often indicate supraventricular tachycardia (SVT). This infant will display persistent ventricular rates of over 200 to 220 beats/min and little variability in heart rate with various activities (e.g., crying, feeding, apnea). 

125.

For the placement of a peripherally inserted central catheter (PICC) in a neonate, a nurse should provide all the following interventions for neonatal pain relief, EXCEPT:

  • Skin-to-skin/kangaroo care

  • Nonnutritive sucking

  • Swaddling, holding, and rocking

  • Opioid administration

Correct answer: Skin-to-skin/kangaroo care

Evidence-based pain management strategies for PICC line insertion include oral nonnutritive sucking or a sucrose pacifier, swaddling, holding and rocking, topical numbing medications at the site of insertion such as EMLA cream or amethocaine gel, and opioid administration. 

Kangaroo care is not recommended for PICC line insertion.

126.

All the following are associated with an increased risk of neonatal central line-associated bloodstream infections (CLABSIs), EXCEPT: 

  • Frequent handwashing

  • Longer dwell times for catheters

  • Utilizing the femoral vein for percutaneous catheter placement

  • Changing dressings every 10 days or when loose, damp, or visibly soiled. 

Correct answer: Frequent handwashing 

CLABSIs remain a prominent concern in NICU settings. As a subset of nosocomial infections, CLABSI is defined as a bloodstream infection with an initial positive blood culture that occurs at least 2 days after placement or less than 2 days before a central line is placed or removed, with the infection not attributable to another site. Hand hygiene remains the single most important procedure for controlling infection in the NICU (and preventing healthcare-acquired infections). Meticulous and frequent hand hygiene is a strategy that must be implemented to prevent CLABSIs. 

Longer dwell times for catheters are associated with increased CLABSIs. Utilizing the femoral vein for catheter placement increases the risk of infection (thus, the femoral vein should be avoided). Dressings should be changed every 7 days and/or as needed if the dressing becomes moist, loose, or visibly soiled.

127.

A nurse is caring for an infant with bronchopulmonary dysplasia (BPD) who has been treated chronically with furosemide (Lasix). This infant is at an increased risk for all the following electrolyte disturbances, EXCEPT: 

  • Hypophosphatemia

  • Hypokalemia

  • Hyponatremia

  • Hypochloremia

Correct answer: Hypophosphatemia

Furosemide (Lasix) is the most widely studied diuretic in neonates and is consequently the prototype loop diuretic. It produces a 10-fold to 35-fold increase in sodium excretion and a 10-fold increase in urine flow. Therefore, hyponatremia, hypochloremia, and hypovolemia are common with the chronic use of furosemide. Hypokalemia is also of significant concern with chronic use of furosemide, as well as hypocalcemia, renal calcifications, and gallstones. 

In addition to potassium loss, furosemide promotes urine calcium and magnesium excretion. Because of these side effects, KCl supplementation is necessary. 

Long-term use of furosemide is not commonly associated with an increased risk of low phosphate levels in neonates. 

128.

At birth, an infant takes their first few breaths, and the placenta is removed from the circulation. What happens to the newborn's systemic vascular resistance (SVR) at this time?

  • It increases significantly.

  • It decreases significantly.

  • It increases slightly.

  • It decreases slightly.

Correct answer: It increases significantly.

The labor process and an infant's first few breaths begin the termination of fetal circulation and the transition to newborn circulation. At birth, when the umbilical cord is occluded and the placenta is removed from circulation, the infant's SVR greatly increases. The first few breaths inflate the lungs for the first time and increase the oxygen content in the infant's blood. Both of these changes decrease pulmonary vascular resistance (PVR), leading to increased pulmonary blood flow.

129.

What is the MOST likely maternal condition to result in fetal macrosomia?

  • Diabetes

  • Gestational hypertension

  • Hypothyroidism

  • Renal disease

Correct answer: Diabetes

Fetal macrosomia, in which an infant is born weighing above the 90th percentile, occurs in up to 42% of diabetic pregnancies because of hyperinsulinemia. Maternal hyperglycemia results in increased fetal insulin production, which promotes fetal growth. 

Macrosomic infants have an increased risk of shoulder dystocia during vaginal birth, brachial plexus injury, and facial nerve palsy; their laboring mothers may display dysfunctional labor patterns and experience operative vaginal birth or emergency cesarean delivery. 

130.

Treatment for apnea of prematurity may include all the following, EXCEPT:

  • Norepinephrine

  • Tactile stimulation

  • Theophylline

  • Caffeine

Correct answer: Norepinephrine

Treatment of primary apnea, or apnea of prematurity, should begin with the least invasive intervention possible. Gentle tactile stimulation is often successful, especially with early recognition. When infants do not immediately respond to external stimuli, bag-and-mask ventilation must be initiated; low-pressure nasal CPAP or mechanical ventilation may be necessary if the infant fails to respond to other measures and continues to have repeated and prolonged apneic episodes. 

Methylxanthines, such as caffeine citrate and theophylline, are used to treat apnea of prematurity and are used only for primary apnea when pathologic causes have been eliminated and when the infant fails to respond to lesser measures alone. These drugs reduce the frequency of apnea and are associated with a decrease in the use of mechanical ventilation.

131.

What is the MOST common diagnosis for neonatal seizures? 

  • Hypoxic-ischemic encephalopathy (HIE) 

  • Meningitis secondary to bacterial infection

  • Intracranial hemorrhage (ICH)

  • Withdrawal from maternal drugs

Correct answer: Hypoxic-ischemic encephalopathy (HIE) 

A seizure is a symptom of neurologic dysfunction, not a specific disease entity. Seizures may be associated with many disorders that directly or indirectly affect the brain by altering its electrochemical stability. Seizures often occur in response to hypoxia during a perinatal event; hypoxic ischemia is the most common diagnosis, accounting for 60% of neonatal seizures.

Infections make up 12% of cases, ICH makes up 15% of cases, and withdrawal from maternal drugs is an uncommon cause of seizures but occasionally occurs (jitteriness is more commonly seen in drug withdrawal). 

132.

Which of the following should be initiated for infants born before 32 weeks of gestation to decrease the incidence of RDS?

  • A course of antenatal steroids

  • Surfactant replacement therapy

  • Nitric oxide therapy

  • Inositol therapy

Correct answer: A course of antenatal steroids 

A single course of antenatal steroids (betamethasone or dexamethasone) decreases the incidence and severity of RDS, comorbid conditions, and mortality in infants born before 32 weeks of gestation. It is considered prophylactic therapy for infants born at or before 32 weeks. 

Corticosteroid therapy is recommended for pregnant women between 24 and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including those with ruptured membranes and multiple gestations, and may be considered starting at 23 weeks of gestation if there is a risk of preterm delivery within 7 days, irrespective of membrane status. 

Treatment of RDS may involve the other choices.

133.

A NICU nurse would expect to see symptoms of drug withdrawal in a neonate born to a mother with a drug addiction by which period?

  • 72 hours

  • 4 to 5 days

  • 48 hours

  • 5 to 7 days 

Correct answer: 72 hours

The onset of withdrawal symptoms varies from minutes or hours after birth to up to 2 weeks of age, but the majority of symptoms manifest within the first 24 to 72 hours after birth. Infants born to mothers requiring or taking an opiate with a short half-life (hydrocodone) may be discharged after 72 hours if they do not have signs of withdrawal. 

Infants exposed to maternal opiates with a long half-life (methadone, buprenorphine) should be monitored for 5 to 7 days. 

134.

Which ethical principle is mandated by HIPAA laws? 

  • Patient confidentiality 

  • Patient justice

  • Patient autonomy

  • Patient fidelity 

Correct answer: Patient confidentiality 

Protection of patient privacy and confidentiality is an ethical and legal (state and federal) obligation. 

Compliance to protect patient privacy, secure private patient information, and protect patient confidentiality is mandatory (in the United States) under the Health Insurance Portability and Accountability Act (HIPAA). HIPAA violations may result in financial penalties ($100 to $250,000) and/or imprisonment.  

135.

A neonate born prematurely via cesarean section at 28 weeks of gestation and weighing just over 1,000 g develops respiratory distress syndrome (RDS) soon after birth. The infant exhibits increasing respiratory difficulty related to progressive atelectasis in the first 6 hours after birth, leading to hypoxia and hypoventilation, and requires respiratory support and surfactant replacement therapy. 

This infant's chest x-ray reveals hazy lung fields with fuzzy heart borders and a "whiteout" appearance. This indicates which of the following complications? 

  • Acute pulmonary edema 

  • Bronchopulmonary dysplasia (BPD)

  • Pneumonia 

  • Atelectasis 

Correct answer: Acute pulmonary edema 

Chest x-ray findings in RDS include reduced lung volume, air bronchograms, reticulogranularity, and lung opacification. 

Acute pulmonary edema is a complication of RDS and is evidenced by hazy lung fields with fuzzy heart borders on chest x-ray films. This loss of visible heart borders with a "whiteout" appearance is from the diffuse lung opacification in RDS. 

136.

An infant's parents have just arrived at the NICU to spend time with their newly admitted infant, and they do not speak English. They are from India and speak Punjabi, a dialect of Hindi. A professional translator who speaks this particular dialect is not available to come to the hospital right away, as it is late at night. 

What is the MOST appropriate action? 

  • Call a translator service on speakerphone to interpret 

  • Ask the parents to call an English-speaking family member if possible to provide translation and emotional support 

  • Call the hospital operator to find a staff member who speaks Punjabi

  • Explain as best as possible that no interpreter service is available until tomorrow morning 

Correct answer: Call a translator service on speakerphone to interpret 

Utilize a telephone translator service to provide direct translation via a speakerphone interpreter until the in-person translator is available. 

Using a staff or family member is not advised in this scenario, as they are not professional translators and may not be able to translate medical terminology appropriately. Family members should only be used as a last resort. 

137.

Hyperoxia in an infant is defined as a PaO2 above which value?

  • 80 mm Hg

  • 60 mm Hg

  • 70 mm Hg

  • 90 mm Hg

Correct answer: 80 mm Hg

Hyperoxia occurs when cells, tissues, and organs are exposed to an excess supply of oxygen (O2) or a higher partial pressure of oxygen in arterial blood (PaO2). An infant who is hyperoxic has a PaO2 of greater than 80 mm Hg (normal values are between 60 and 80 mm Hg). Therefore, monitoring of oxygen saturations and partial pressure of oxygen with arterial blood gases is mandatory whenever oxygen is administered to infants.

138.

Breastfeeding is associated with a reduced risk of postpartum depression (PPD) when it is maintained for how long?

  • 4 months

  • 2 months

  • 12 months

  • 8 months

Correct answer: 4 months 

Postpartum depression (PPD) may occur from birth through 6 months postpartum. Studies have demonstrated, however, that when breastfeeding is maintained over the first 4 months of the postpartum period, there is an associated decreased risk of PPD. Women with postpartum depressive symptoms breastfeed an average of 2.4 weeks shorter than women without symptoms.

When considering psychotropic medications, the patient's breastfeeding wishes need to be addressed; all psychotropic drugs enter breast milk, so a careful evaluation by the healthcare team needs to be undertaken.

139.

An infant born at 35 weeks gestational age via vaginal delivery weighs 2,200 grams. What weight category matches this infant?

  • Preterm moderately low birth weight (MLBW)

  • Preterm normal birth weight (NBW)

  • Preterm excessive birth weight (EBW)

  • Preterm very low birth weight (VLBW)

Correct answer: Preterm moderately low birth weight (MLBW)

The newborn population can be classified by the use of birth weight, gestational age, and fetal growth patterns.

Classification by birth weight:

  • normal birth weight (NBW): 2,501 to 3,999 g
  • excessive birth weight (EBW): 4,000 g and above
  • low birth weight (LBW): 2,500 g or below, with the following subcategories:
    • MLBW: 1,501 to 2,499 g
    • very low birth weight (VLBW): 1,500 g or below
    • extremely low birth weight (ELBW): 1,000 g or below

Classification by gestational age:

  • full-term: 37 to 41 6/7 weeks
  • post-term: 42 or more weeks
  • preterm: below 37 weeks

Thus, an infant born at 35 weeks gestational age and weighing 2,200 grams would be classified as a preterm MLBW infant.

140.

Which of the following infants has the LOWEST risk of hypoglycemia?

  • A 41-week infant with hip dysplasia

  • A 37-week infant of a diabetic mother

  • A 38-week infant with intrauterine growth restriction (IUGR)

  • A 34-week infant experiencing hypothermia

Correct answer: A 41-week infant with hip dysplasia 

Although post-term birth can pose a risk of hypoglycemia if an infant is not fed, the risk is relatively low for an infant who is feeding well. Hip dysplasia is not a risk for alterations in blood glucose levels. 

Prematurity, hypothermia, IUGR, and maternal diabetes all increase the risk of hypoglycemia and are indications for routine monitoring of blood glucose to prevent neonatal hypoglycemia.

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