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Quiz Session - Attempts With Random Questions

AACN CCRN (Neonatal) Exam Questions

Page 8 of 25

141.

What is the leading cause of anemia in infancy and childhood?

  • Iron-deficiency anemia

  • Anemia of prematurity

  • Fanconi's anemia

  • Diamond-Blackfan anemia

Correct answer: Iron-deficiency anemia 

Worldwide, iron-deficiency anemia is the leading cause of anemia in infancy and childhood. It can occur at any time when growth exceeds the ability of the stores and dietary intake to supply sufficient iron for erythropoiesis. 

Anemia of prematurity is common in infants born before 35 weeks of gestation. Fanconi's anemia is a congenital syndrome of progressive bone marrow failure with autosomal-recessive inheritance. Diamond-Blackfan anemia is caused by more than 200 unique mutations in ribosomal protein genes.

142.

All the following statements are true about infant-parent bonding, EXCEPT: 

  • Immediately after the infant is born, healthy mothers and infants are not yet ready for reciprocal interaction

  • Bonding is affected by the birth of a premature or ill infant

  • Bonding occurs at different times and in diverse ways for parents

  • Bonding is gradual 

Correct answer: Immediately after an infant is born, mothers and infants are not yet ready for reciprocal interaction

Immediately after birth, healthy mothers and infants are physiologically and psychologically ready for reciprocal interaction. Even though labor and birth are exhausting, most mothers have a surge of energy directly after delivery and are ready to interact with their long-awaited newborn. Similarly, the first hour after birth can be a time of alertness and bonding for the newborn. 

Bonding is a gradual process that occurs differently for both parents. Prematurity or illness in an infant can increase parental vulnerability and the family's ability to establish a nurturing relationship.

143.

What type of clinical research tests hypotheses by using arbitrarily assigned treatment and control groups of adequate size to examine the efficacy and safety of a new therapy?

  • Randomized controlled trials (RCTs)

  • Nonrandomized studies with concurrent controls

  • Nonrandomized studies with historical controls

  • Meta-analysis

Correct answer: Randomized controlled trials (RCTs)

RCTs test hypotheses by using randomly assigned treatment and control groups of adequate size to examine the efficacy and safety of a new therapy. In theory, random assignment of the treatment balances unknown or unmeasured factors that could otherwise bias the outcome of the trial. 

144.

An infant is receiving treatment for intravenous (IV) extravasation. Which of the following is the MOST appropriate dressing to use to facilitate moisture-retentive healing and regeneration of the epidermis? 

  • Hydrocolloid dressing

  • Petroleum gauze

  • Silver sulfadiazine 

  • Polyurethane film 

Correct answer: Hydrocolloid dressing

The evidence for hydrocolloid dressings supports their use as an effective method for treating wounds secondary to IV extravasation in neonates. 

The positive effects of moisture on wound healing include facilitating new epithelial tissue growth, protecting the wound from infection and trauma, and preventing scarring. Hydrocolloid dressings are made up of primarily water, which is soothing, gentle to the skin, and keeps the wound moist. 

145.

What is the effect on an infant's blood gases when positive inspiratory pressure (PIP) is increased during mechanical ventilation?

  • Increased PaO2, decreased PaCO2, increased pH

  • Increased PaO2, increased PaCO2, decreased pH

  • Decreased PaO2, decreased PaCO2, increased pH

  • Decreased PaO2, increased PaCO2, decreased pH

Correct answer: Increased PaO2, decreased PaCO2, increased pH

If PIP is increased on a mechanical ventilator, the result will be an increase in PaO2, a decrease in PaCO2, and an increase in pH.

146.

Which of the following statements regarding a congenital diaphragmatic hernia (CDH) is TRUE?

  • CDH leads to a variable extent of pulmonary hypoplasia.

  • Morgagni diaphragmatic hernias account for nearly 95% of all CDH cases.

  • Early repair of CDH within 72 hours of birth is indicated for optimal outcomes.

  • With CDH, the anteroposterior diameter of the chest may be decreased.

Correct answer: CDH leads to a variable extent of pulmonary hypoplasia. 

CDH is a defect in the closure of the diaphragm; it is a herniation of the abdominal viscera through the diaphragmatic defect in utero. This herniation impairs lung development, and compression of the developing lung leads to variable pulmonary hypoplasia.

A posterolateral defect, or a Bochdalek diaphragmatic hernia, accounts for nearly 95% of all CDH and may be left-sided (95%) or right-sided (5%). Much less common is the Morgagni diaphragmatic hernia, which results from a failure of anteromedial closure in a substernal location. Surgical repair does not alter early outcomes. Therefore, a baby's condition should be stabilized, and efforts should be directed toward the management of the associated pulmonary hypoplasia and hypertension. Early repair within the first 72 hours after birth is indicated only for infants having little or no pulmonary dysfunction. With CHD, much of the bowel is herniated into the chest, and the abdomen appears scaphoid. The anteroposterior diameter of the chest may enlarge (not decrease) as the bowel distends with air. Breath sounds are diminished or absent on the affected side.

147.

Which type of bilirubin is found in cord blood? 

  • Unconjugated bilirubin

  • Conjugated bilirubin

  • Free bilirubin

  • Direct bilirubin

Correct answer: Unconjugated bilirubin

All cord blood found in a fetus is unconjugated and is metabolized, conjugated, and excreted by the maternal gallbladder and liver. If an infant is unaffected by hemolytic disease, the mean cord blood bilirubin concentration is 1.8 mg/dL. This value is independent of and unaffected by the infant's gestational age or weight. 

Direct bilirubin is also known as conjugated bilirubin.

148.

A preterm infant born before 36 weeks of gestation will primarily exhibit which of the following sleep states?

  • Transitional sleep

  • Quiet sleep

  • Active sleep

  • REM sleep

Correct answer: Transitional sleep 

For preterm infants, active and quiet sleep cycles are less organized and shorter than for term infants. Active sleep (light or REM sleep) is "lighter" than quiet sleep (deep or non-REM sleep). Infants are more responsive to stimuli in active sleep. 

Quiet sleep is more controlled and occurs more frequently in term infants. A third sleep state called transitional sleep has been identified for premature infants and is characterized by quiet sleep with periods of closed eyes, regular or periodic breathing, no body movements, and no REM. Before 36 weeks of gestation, an infant's primary sleep state is transitional sleep.

149.

All the following categories influence changes in nursing practice to improve quality of care, EXCEPT: 

  • Inconsistency in practice

  • Staffing issues

  • Multidisciplinary approach to care

  • Feedback process

Correct answer: Inconsistency in practice

Quality care is a major issue that influences the delivery of healthcare services, yet little research has been conducted on what parents of premature infants perceive as quality nursing care. 

A qualitative study conducted on this topic revealed seven categories that influence changes in practice: staffing issues, consistency in practice, the approval process for change, a multidisciplinary approach to care, frequency and consistency of communication, a rationale for change, and the feedback process.

150.

Risk factors for group B streptococcus (GBS) infection for neonates include a maternal history of all the following, EXCEPT: 

  • Gestation under 35 weeks

  • Rupture of membranes for 18 hours or longer

  • Maternal temperature of 38 degrees C (100.4 degrees F) or higher

  • Birth of a previous infant with GBS infection

Correct answer: Gestation under 35 weeks

Risk factors for GBS for neonates include a maternal history of:

  • gestation under 37 weeks (not 35 weeks)
  • ROM for 18 hours or longer
  • a maternal temperature of 38 degrees C (100.4 degrees F) or higher
  • GBS bacteriuria during the current pregnancy
  • birth of a previous infant with GBS infection

151.

A term infant born to a mother with polyhydramnios develops abdominal distension and bilious vomiting 6 hours after delivery. A plain abdominal x-ray shows a "double bubble" pattern. The nurse suspects the infant has which of the following conditions? 

  • Duodenal stenosis

  • Pyloric stenosis

  • Tracheoesophageal fistula (TEF)

  • Biliary atresia 

Correct answer: Duodenal stenosis

Duodenal stenosis and atresia is a congenital obstruction of the duodenum. The defect usually occurs distal to the ampulla of Vater and can be partially or completely obstructed. A history of polyhydramnios, bilious vomiting in the first 24 hours, abdominal distention, and absence of stools are classic clinical signs of this defect. 

The initial evaluation of suspected duodenal stenosis or atresia begins with a plain abdominal radiograph (flat and left lateral decubitus views), which classically shows gaseous distention (a dilated air-filled stomach), and the proximal duodenum in the double bubble pattern. An ultrasound is an adjunctive diagnostic test. 

152.

For infants born with hypoplastic left heart syndrome (HLHS), why is PGE1 with continuous infusion required?

  • To keep the ductus arteriosus patent

  • To manage acidosis aggressively 

  • To increase pulmonary vascular resistance

  • To decompress the left atrium 

Correct answer: To keep the ductus arteriosus patent 

HLHS typically involves severe coarctation of the aorta, aortic valve stenosis or atresia, and mitral valve stenosis or atresia. The left ventricle and ascending aorta are hypoplastic, and blood flow to the body is dependent on right-to-left shunting through the PDA. Closure of the ductus arteriosus results in poor systemic perfusion and death. Therefore, pharmacologic maintenance of ductal patency with PGE1 with continuous infusion is required. 

The goal is a balanced pulmonary and systemic circulation through the use of volume expansion, inotropic support, and intubation. Maneuvers such as hypoventilation to increase PVR and redirect cardiac output to the body have been used. Palliative cardiac surgeries are required for survival and occur over the first few years of life.

Other management options include systemic afterload-reducing agents, aggressive management of acidosis, and transcatheter balloon atrial septostomy to decompress the left atrium if the patient is not taken to surgery immediately after birth. 

153.

Which of the following is considered to be the primary cause of skin breakdown among NICU patients?

  • Application and removal of adhesives

  • Excessive use of skin disinfectants

  • Frequent bathing

  • Frequent handling

Correct answer: Application and removal of adhesives

One of the most common practices in the NICU is the application and removal of adhesives that secure endotracheal tubes, IV devices, and monitoring probes and electrodes. A research utilization project involving nearly 3,000 premature and term newborns found that adhesives were the primary cause of skin breakdown among NICU patients. Types of damage from adhesive removal include epidermal stripping, tearing, maceration, tension blisters, chemical irritation, sensitization, and folliculitis. 

Although the other choices do pose a risk of skin breakdown, they are not found to be the primary cause of it.

154.

An infant is born vaginally at 41 weeks of gestation with meconium-stained fluid. The neonate is suspected of having aspirated meconium during delivery based on signs of respiratory distress immediately following delivery. The infant is deep suctioned, and meconium is extracted from their airway. 

A chest x-ray would reveal which of the following findings indicating meconium aspiration syndrome (MAS)? 

  • Streaky and patchy infiltrates

  • Either diffuse or focal infiltrates

  • Diffuse granularity with air bronchograms

  • Increased pulmonary vascularity or edema 

Correct answer: Streaky and patchy infiltrates

Meconium-stained amniotic fluid is present in approximately 8% to 29% of all newborns delivered. Of these, between 3% and 12% develop MAS. 

MAS is a disease of term or post-term infants; it is rarely seen in infants born before 36 weeks of gestation. Vigorous resuscitation is frequently needed in the delivery room because of central depression. Respiratory distress signs are nonspecific and can include tachypnea, nasal flaring, and retractions. Manifestations can range from mild and transient to severe and prolonged. 

Chest imaging shows streaky and patchy infiltrates; hyperexpanded lucent areas mixed with areas of atelectasis throughout lung fields. Ancillary findings include air leak syndrome (i.e., pneumothorax).

Either diffuse or local infiltrates are indicative of neonatal pneumonia. Diffuse granularity with air bronchogram often signals hyaline membrane disease. Congenital heart disease will show increased pulmonary vascularity or edema on chest x-ray films. 

155.

In addition to spina bifida, what other neural tube defects (NTDs) can result from a maternal deficiency in folic acid?

  • Myelomeningoceles and anencephaly

  • Microcephaly and Dandy-Walker syndrome 

  • Craniosynostosis and hydrocephalus

  • Down syndrome and macrosomia

Correct answer: Myelomeningoceles and anencephaly

Myelomeningoceles are a limited form of myeloschisis with failed closure at the caudal (tail) end of the neural tube. They result in the protrusion of both meninges and spinal cord through the opening in the spinal column. 

Anencephaly essentially consists of no normal brain tissue above the brainstem and thalami, and parts of those structures are malformed. Both of these conditions are NTDs related to folic acid deficiency. 

Other NTDs associated with folic acid deficiency include craniorachischisis, myeloschisis, encephalocele, and Chiari malformation. 

156.

Neonatal cardiogenic shock usually relates to congenital heart disease (with systemic to pulmonary shunting), myocarditis, and dysrhythmia. It involves three characteristics. Which of the following is NOT a characteristic of cardiogenic shock in neonates? 

  • Decreased systemic vascular resistance (SVR) 

  • Increased afterload 

  • Decreased contractibility 

  • Increased preload 

Correct answer: Decreased systemic vascular resistance (SVR) 

Cardiac signs of shock include pulmonary hypertension (increased systemic vascular resistance), decreased cardiac output, and hypoxemia in the early phase, followed by an uncompensated decrease in cardiac output (CO), bradycardia, and hypotension. Increased preload, increased afterload, and decreased contractibility result in decreased CO and increased SVR to compensate for and protect vital organs. 

As CO continues to decrease, tissue perfusion and coronary artery perfusion decrease, fluid backs up, and the left ventricle fails to pump the blood adequately, resulting in pulmonary edema and right ventricular failure. 

157.

Qualitative research contributes to evidence-based practice (EBP) in all the following areas, EXCEPT: 

  • Finalizing results and supporting or disproving a hypothesis

  • Facilitating an understanding of the experience and values of patients

  • Providing the framework for instrument development and evaluation

  • Elaborating concepts relative to theory development

Correct answer: Finalizing results and supporting or disproving a hypothesis

Quantitative (not qualitative) research contributes to EBP by finalizing results and supporting or disproving a hypothesis. It is useful for testing the results gained by a series of qualitative experiments, leading to a final answer and a narrowing of possible directions for follow-up research. 

The other choices are correct with respect to how qualitative research contributes to EBP.

158.

What is the hematocrit range for the majority of healthy term infants? 

  • 48% to 60%

  • 38% to 50%

  • 58% to 70%

  • 28% to 40%

Correct answer: 48% to 60%

For most healthy term infants, the hematocrit range is 48% to 60%, and the hemoglobin range is 16 to 20 g/dL. 

Hematocrit changes significantly during the first 24 hours after birth; it peaks at two hours of age and then drops steadily, with decreases determined at 6 and 24 hours of age.

159.

All the following are ways to reduce medication errors in the NICU, EXCEPT: 

  • Avoiding the use of the terminal zero to the left of the decimal point when writing a drug dosage

  • Completing the "six rights" of medication administration

  • Avoiding the use of abbreviations for drug names

  • Using generic medication names rather than trade names

Correct answer: Avoiding the use of the terminal zero to the left of the decimal point when writing a drug dosage

Completing the "six rights" of drug administration (right drug, patient, route, dose, time, and response) greatly reduces medication errors in the NICU. In addition, avoiding the use of abbreviations of drug names and using generic medication names rather than trade names are also strategies to reduce medication errors.

Avoiding the use of the terminal zero to the right of the decimal point (e.g., writing 2 instead of 2.0), and utilizing a zero to the left of a dose less than 1 (e.g., 0.2 rather than .2) will help reduce medication errors.

160.

A nurse is placing leads on an infant in preparation for a 12-lead ECG. Where is precordial lead V6 placed? 

  • Horizontal to V5 at the left midaxillary line 

  • Horizontal to V5 at the left anterior axillary line 

  • Left midclavicular line at the fifth intercostal space (ICS)

  • Left sternal border at the fourth intercostal space (ICS) 

Correct answer: Horizontal to V5 at the left midaxillary line 

An ECG provides a graphic representation of the electrical activity of an infant's heart. It is indicated for cyanosis, cardiac arrhythmias, dyspnea, or other cardiovascular disorders and is used to determine the severity of disease by assessing the degree of atrial or ventricular hypertrophy. A standard 12-lead ECG gives a picture of electrical activity from 12 perspectives through the placement of 10 body leads:

  • Four limb leads are placed distally (on the wrists and ankles) but can be placed more proximally if necessary.
  • Precordial leads are as follows:
    • V1: Right sternal border at the fourth ICS
    • V2: Left sternal border at the fourth ICS
    • V3: Midway between V2 and V4
    • V4: Left MCL at the fourth ICS
    • V5: Horizontal to V4 at the left anterior axillary line
    • V6: Horizontal to V5 at the left midaxillary line 
  • In some cases, additional leads may be used:
    • Right-sided leads are placed on the right in a mirror-image of the left leads, usually to diagnose right-ventricular infarction through ST elevation.
    • Artifacts are COMMON in neonatal ECGs because of movement or incorrect lead placement.
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