CCPR

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vhnicholas
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74870
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CCPR
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2011-03-29 23:20:51
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CCPR
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CCRP
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  1. Neonates born to mothers with a seizure disorder are at increased risk for
    A. neurologic disorders
    B. respiratory distress syndrome
    C. prematurity
    C. prematurity
    (this multiple choice question has been scrambled)
  2. Maternal renal adaptation to pregnancy involves an increase in
    A. renal blood flow in the second trimester
    B. retention of sodium and water
    C. renal vascular resistance
    B. retention of sodium and water
    (this multiple choice question has been scrambled)
  3. Untreated maternal phenylketonuria can lead to
    A. cardiac defects
    B. preterm delivery
    C. macrocephaly
    A. cardiac defects
    (this multiple choice question has been scrambled)
  4. Unregulated glucose control in a woman with diabetes early in pregnancy can predispose the fetus to
    A. fetal diabetic ketoacidosis
    B. macrosomia and organomegaly
    C. congenital anomalies
    C. congenital anomalies
    (this multiple choice question has been scrambled)
  5. Neonatal manifestation of systemic lupus erythematosus is attributed to
    a. interference with protein synthesis
    b. maternal deficiency of autoantibodies and immune complexes c. placental transfer of antibodies to the fetus
    c. placental transfer of antibodies to the fetus
  6. Common behavioral manifestations of neonates who were exposed to cocaine in utero include
    A. difficulty alternating between alert and drowsy states
    B. stimulated interactive behaviors and response to stimuli
    C. drowiness followed by hyperirritability
    A. difficulty alternating between alert and drowsy states
    (this multiple choice question has been scrambled)
  7. In women with multiple sclerosis, expected neonatal outcomes include
    A. poor muscle tone
    B. full term delivery
    C. low birth weight
    B. full term delivery
    (this multiple choice question has been scrambled)
  8. In a 32 week gestational age neonate, the expected muscle development would include a
    A. weak sucking reflex
    B. complete Moro response
    C. good grasp reflex
    C. good grasp reflex
    (this multiple choice question has been scrambled)
  9. A physical finding consistent with extreme prematurity is
    A. flat areola and no breast bud
    B. sparse lanugo
    C. smooth pink skin with visible veins
    B. sparse lanugo
    (this multiple choice question has been scrambled)
  10. A neonate born at 36 weeks gestation weighing 3000 gm is at increased risk for
    A. increased jaundice
    B. polycythemia
    C. hypoglycemia
    A. increased jaundice
    (this multiple choice question has been scrambled)
  11. When performing a gestational age assessment, the nurse should recognize that a finding that correlates with advancing gestional age is increased
    A. square window angle
    B. degree of arm flexion with arm recoil manuver
    C. resistance with scarf sign maneuver
    C. resistance with scarf sign maneuver
    (this multiple choice question has been scrambled)
  12. Neuromuscular development characteristic of prematurity includes increased
    A. heel to ear resistance
    B. hip flexion and adduction
    C. popliteal angle
    C. popliteal angle
    (this multiple choice question has been scrambled)
  13. In examining the eye of a black newborn, a bright light directed toward the lens reveals a red-orange color that is reflected back to the examiner. The finding is consistent with
    a. an intact lens
    b. cateracts
    c. retinoblastoma
    an intact lens
  14. The Ortolani maneuver can be described as
    A. reducing a dislocated femoral head into the acetabulum
    B. demonstrating symmetry of hip range of motion
    C. reflecting the ability of the femoral head to be dislocated
    A. reducing a dislocated femoral head into the acetabulum
    (this multiple choice question has been scrambled)
  15. During a physical examination of a 29 week gestational age neonate, the grasp reflex is good, but the suck reflex is weak and not synchronized with swallowing. The nurse should recognize that this is due to
    A. prematurity
    B. cerebal palsy
    C. neurological impairment
    A. prematurity
    (this multiple choice question has been scrambled)
  16. A preterm neonate who required resuscitation at birth is admitted to the neonatal intensive care nursery in stable condition. Care of this infant should include
    A. a chest x-ray to rule out pneumothorax
    B. oral feeding to prevent hypoglycemia
    C. insertion of arterial line to monitor PaO2
    A. a chest x-ray to rule out pneumothorax
    (this multiple choice question has been scrambled)
  17. After administration of 100% Fi02 for 10 minutes to an infant with cyanosis of cardiac origin, the nurse would expect the Pa02 to
    A. remain the same
    B. increase
    C. decrease
    A. remain the same
    (this multiple choice question has been scrambled)
  18. A neonate has a flat pink lesion on the face. The lesion has diffusely delineatued borders, and blanching occurs when pressure is applied. The nurse should suspect
    A. nevus simplex
    B. port wine stain
    C. hemangioma
    A. nevus simplex
    (this multiple choice question has been scrambled)
  19. A 2500 gm neonate with birth asphyxia develops hypocalcemia. This is most likely a result of increased
    A. parathyroid hormone
    B. calcitonin
    C. 1, 25 dihydroxyvitamin D resistance
    B. calcitonin
    (this multiple choice question has been scrambled)
  20. A neonate is oliguric. A 10-20 ml/kg body weight test dose of isotonic solution is given IV over 1 hour. If the problem is prerenal, the urine output will
    a. decrease
    b. increase
    c. remain unchanged
    increase
  21. The maturity of hypertention in infants can be accounted for as a result of
    A. rapid volume overload
    B. umbilical artery catheter complications
    C. repeated sodium bicarbonate administration
    B. umbilical artery catheter complications
    (this multiple choice question has been scrambled)
  22. Orotracheal intubation is preferable to nasotracheal intubation during acute neonatal resuscitation because
    A. the endotracheal tube is easier to stabilize
    B. it can be performed without additional equipment
    C. a smaller size endotracheal tube can be utilized
    B. it can be performed without additional equipment
    (this multiple choice question has been scrambled)
  23. When determining the amount of supplemental oxygen to administer in neonatal resuscitation the goal is to
    A. avoid hyperoxia
    B. generate oxygen free radicals
    C. maintain Fi02 consistently at 90-100%
    B. generate oxygen free radicals
    (this multiple choice question has been scrambled)
  24. After an initial resusciation, poor perfusion continues, pulses are thready, and the neonate appears in shock. Dopamine is administered as a continuous IV infusion. The nurse should recognize that
    A. the serum half-life is 1-2 minutes
    B. beneficial effects are dependent on adequate blood volume
    C. increased blood pressure can be expected at low doses
    B. benefical effects are dependent on adequate blood volume
    (this multiple choice question has been scrambled)
  25. A vigorous neonate is born with thick meconium present in the amniotic fluid. After placing the baby on a warmed radiant warmer and positioning the head, the next step in resuscitation should be
    A. endotracheal suctioning
    B. bulb syringe suctioning
    C. evaluation of respirations
    B. bulb syringe suctioning
    (this multiple choice question has been scrambled)
  26. When resuscitating a neonate with suspected diaphragmatic hernia, the nurse should recognize that
    A. insertion of an endotracheal tube should be done as quickly as possible to prevent gas from entering the intestines
    B. bag and mask ventilation should be initiated immediately to maximize pulmonary function
    C. a cuffed endotracheal tube should be inserted to prevent air leak around the tube
    A. insertion of an endotracheal tube should be done as quickly as possible to prevent gas from entering the intestines
    (this multiple choice question has been scrambled)
  27. Prior to administration of sodium bicarbonate for resuscitation, the following should be established
    A. adequate ventilation
    B. documentation of respiratory acidosis
    C. correction of hypovolemic shock
    A. adequate ventilation
    (this multiple choice question has been scrambled)
  28. The priniciple action of epinephrine during resuscitation is to
    A. improve plasma and blood volume expansion
    B. increase effects of sympathetic nervous system
    C. promote peripheral vasoconstrictor
    A. improve plasma and blood volume expansion
    (this multiple choice question has been scrambled)
  29. There is an increased risk of hyperchloremia in neonates who
    A. have been diagnosed with renal tubular acidosis
    B. have pyloric stenosis
    C. are being fed on soy formulas
    A. have been diagnosed with renal tubular acidosis
    (this multiple choice question has been scrambled)
  30. Neonatal hypocalcemia is most likely to occur with
    A. perinatal asphyxia
    B. hyperparathyroidism
    C. postmaturity
    A. perinatal asphyxia
    (this multiple choice question has been scrambled)
  31. Hyperkalemia in the very low birth weight neonate with normal urine output during the first few hours of life is mainly due to
    A. limited reabsorption capacity of the tubule
    B. distal tubular dysfunction
    C. high efflux of potassium from the intracellular compartment
    C. high efflux of potassium from the intracellular compartment
    (this multiple choice question has been scrambled)
  32. The most common cause of acute tubular necrosis in the preterm neonate is
    A. sepsis
    B. congenital anomalies
    C. asphyxia
    A. sepsis
    (this multiple choice question has been scrambled)
  33. A term neonate has hyponatremia with decreased urine sodium and reduced urine output. The most likely cause is
    A. renal loss of sodium due to diuretic therapy
    B. syndrome of inappropriate antidiuretic hormone secretion
    C. overhydration secondary to administration of electrolyte-free IV fluids
    C. overhydration secondary to administration of electrolyte-free IV fluids
    (this multiple choice question has been scrambled)
  34. A neonate receiving IV infusion of calcium gluconate for symptomatic hypocalcemia develops bradycardia. The nurse should
    A. slow the rate of administration
    B. recognize this as a transient effect
    C. stop the infusion immediately
    C. stop the infusion immediately
    (this multiple choice question has been scrambled)
  35. A woman is breastfeeding her one week old premature neonate. She wants to use Depo-Provera as her contraceptive method and asks if this will affect her breast milk. She should be advised that Depo-Provera
    A. has no adverse neonatal effect
    B. might cause neonatal colic and/or diarrhea
    C. can be used once lactation is well established
    A. has no adverse neonatal effect
    (this multiple choice question has been scrambled)
  36. A woman on methadone delivers a premature neonate and wants to breastfeed. She should be advised that a. breastfeeding is safe if the methadone dose is less than 50 mg/day
    b. the baby should be weaned gradually to avoid withdrawal
    c. transfer of methadone via breast milk precludes breastfeeding
    b. the baby should be weaned gradually to avoid withdrawal
  37. Markers of impaired fatty acid oxidation in neonates include
    A. hyperketonuria
    B. hypoglycemia
    C. seizures
    B. hypoglycemia
    (this multiple choice question has been scrambled)
  38. When developing a plan for a preterm neonate to transition to oral feedings, the nurse should consider that
    A. non-nutritive sucking prior to feeding increases oxygen saturation levels before and after feeding
    B. using a soft nipple will allow for higher milk flow which facilitates oral feeding
    C. coordination of suck-swallow reflex and breathing is developed by 32 weeks post-conceptual age
    C. coordination of suck-swallow reflex and breathing is developed by 32 weeks post-conceptual age
    (this multiple choice question has been scrambled)
  39. A mother of a preterm neonate plans to breastfeed. The father is bringing the stored frozen breast milk to the NICU each day. When unfreezing the milk, the best method is to
    A. thaw the milk in the refrigerator
    B. use a room temperature bath to thaw the milk
    C. allow the milk to thaw at room temperature
    B. use a room temperature bath to thaw the milk
    (this multiple choice question has been scrambled)
  40. Medium chain triglycerides are added to preterm formula because they
    A. do not require bile salts for absorption
    B. improve the growth of healthy preterm infants
    C. are important for the developing central nervous system
    A. do no require bile salts for absorption
    (this multiple choice question has been scrambled)
  41. When evaluating nutritional requirements for the extremely low birth weight infant, the nurse should recognize that
    A. parenteral nutrition should be initiated by day three of life
    B. gastric residuals indicate feeding intolerance and enteral feeding should be withheld
    C. the gut is incapable of successful digestion and absorption at birth
    C. the gut is incapable of successful digestion and absorption at birth
    (this multiple choice question has been scrambled)
  42. When caring for an infant on total parenteral nutrition, the nurse should recognize that
    A. a dextrose concentration of 12.5% or greater requires a central line
    B. cholestasis may occur as a result of excessive protein intake
    C. nutrient intakes for parenteral nutrition are comparable to those for enteral nutrition
    B. cholestasis may occur as a result of excessive protein intake
    (this multiple choice question has been scrambled)
  43. The primary goal of high-freguency ventilation is to
    A. reverse the progression of pulmonary interstitial emphysema
    B. reduce barotrauma by application early in the course of therapy
    C. enhance oxygen and carbon dioxide exchange
    B. reduce barotrauma by application early in the course of therapy
    (this multiple choice question has been scrambled)
  44. An infant is placed on 30% oxygen by oxyhood 4 hours post-delivery for respiratory distress. An order is obtained for a pulse oximeter. The nurse should recognize that
    A. the pulse oximeter gives a continuous measurement of hemoglobin oxygen saturation
    B. oximeter readings are unaffected by the medication the infant may be receiving
    C. the pulse oximeter will eliminate the need for obtaining arterial blood gas analysis
    A. the pulse oximeter gives a continuous measurement of hemoglobin oxygen saturation
    (this multiple choice question has been scrambled)
  45. A 30-week gestational age neonate is intubated, but air entry is diminished rather than improved as expected. This should lead the nurse to consider that the tube is
    A. too high
    B. too low
    C. plugged
    A. too high
    (this multiple choice question has been scrambled)
  46. A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and a capillary blood gas reveals the following
    pH 7.30, PCO2 50 mm Hg, P02 53 mm Hg, HCO3 24 mEq/L. This blood gas represents
    A. borderline normal finding
    B. metabolic acidosis
    C. respiratory acidosis
    C. respiratory acidosis
    (this multiple choice question has been scrambled)
  47. A preterm neonate had a prolonged resuscitation at birth. The infant is still experienceing respiratory distress and a capillary blood gas reveals the following
    pH 7.30; PC02 50 mm Hg, PO2 53 mm Hg, HC03 24 mEq/L
    When interpreting this arterial blood gas, it should be recognized that
    A. tissue oxygen supply is inadequate
    B. the metabolic component is abnormal
    C. the primary problem is respiratory
    C. the primary problem is respiratory
    (this multiple choice question has been scrambled)
  48. A preterm neonate had a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and a capillary blood gas reveals the following;
    pH 7.30, PCO2 50 mm Hg, P02 53 mm Hg, HC03 24 mEq/L
    The acid base derangement of respiratory alkalosis represents the presence of
    a. decreased ventilation-perfusion ratio b. increased alveolar ventilation
    c. increased loss of H+ ions
    b. increased alveolar ventilation
  49. An arterial blood gas of a term neonate is taken following abdominal surgery two weeks ago. The neonate is on total parenteral nutrition. pH 7.51, PC02 44 mm Hg, P02 51 mm Hg HC03 36 mEq/L. When interpreting this blood gas, it should be recognized that
    A. the primary problem is metabolic
    B. the primary problem is respiratory
    C. PO2 is inadequate
    A. the primary problem is metabolic
    (this multiple choice question has been scrambled)
  50. A term neonate who was resuscitated for meconium aspiration at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals
    pH 7.23, PC02 49 mm Hg, P02 36 mm Hg, HC03 19 mEq/L
    This blood gas represents
    A. metabolic acidosis
    B. mixed acidosis
    C. compensated respiratory acidosis
    B. mixed acidosis
    (this multiple choice question has been scrambled)
  51. A term neonate who was resuscitated for meconium aspiration at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals
    pH 7.23, PC02 49 mm Hg, P02 36 mm Hg, HC03 19 mEqL
    Initial management of this neonate should include providing supplemental oxygen and
    A. bicarbonate administration
    B. increasing positive end expiratory pressure
    C. increasing peak inspiratory pressure
    C. increasing peak inspiratory pressure
    (this multiple choice question has been scrambled)
  52. When placing a neonate on an oxygen saturation monitor, the nurse should recognize that a primary factor in obtaining an accurate reading is
    A. calibration of the monitor
    B. perfusion status of the infant
    C. adequate warming of the electrode
    B. perfusion status of the infant
    (this multiple choice question has been scrambled)
  53. While caring for an infant born at 38 weeks gestational age who was admitted to NICU to rule out sepsis, the nurse should recognize which of the following physiologic differences between a neonate and adult?
    A. Heat transfer from internal organs to skin surface is decreased in the neonate
    B. Heat production in the neonate results from aerobic metabolism
    C. The shivering threshold is lower in the neonate
    C. The shivering threshold is lower in the neonate
    (this multiple choice question has been scrambled)
  54. Intrauterine growth restricted infants are at risk for decreased glycogen stores because of
    A. altered regulation of insulin secretion in pancreatic beta cells
    B. inhibition of gluconeogenesis secondary to high insulin concentrations
    C. diminished transfer of glycogen precursors across the placenta
    C. diminished transfer of glycogen precursors across the placenta
    (this multiple choice question has been scrambled)
  55. A neutral thermal environment is the environmental temperature in which body temperature is maintained and
    A. skin and core temperature gradient is small
    B. metabolic rate is maximized
    C. oxygen consumption is minimized
    C. oxygen consumption is minimized
    (this multiple choice question has been scrambled)
  56. The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to
    A. limited subcutaneous tissue and brown fat stores
    B. large surface skin area relative to body mass
    C. in utero hypoxia
    A. limited subcutaneous tissue and brown fat stores
    (this multiple choice question has been scrambled)
  57. Interventions to decrease convective heat loss in the delivery room include
    A. providing additional heat source during bath
    B. using transparent plastic covering over the infant
    C. warming the incubator mattress
    B. using transparent plastic covering over the infant
    (this multiple choice question has been scrambled)
  58. Criteria for successful weaning from an incubator to an open crib include that the infant
    A. weighs at least 1200 gms
    B. is free of major medical conditions
    C. has at least three days of consistent weight gain
    B. is free of major medical conditions
    (this multiple choice question has been scrambled)
  59. When an IM injection is necessary for a neonate, the anterior thigh is the site of choice. For an infant weighing <1500 gm, the volume injected into each thigh should not exceed
    A. 0.5
    B. 0.3
    C. 1.0
    A. 0.5
    (this multiple choice question has been scrambled)
  60. The distribution of drugs among organs, fluids, and tissues within the body is dependent on
    A. age
    B. genetic factors
    C. membrane permeability
    C. membrane permeability
    (this multiple choice question has been scrambled)
  61. A premature neonate at one week of age is experiencing apneic episodes about 6-8 times a day. A serum trough level of theophylline drawn this morning is 6.5 pg/mL
    This neonate will require
    A. increased dose of theophylline
    B. caffeine
    C. doxapram
    A. increased dose of theophylline
    (this multiple choice question has been scrambled)
  62. When comparing theophylline and caffeine for treatment of prematurity, the nurse should know that
    A. metabolism of both drugs takes place in the liver
    B. the half-life of theophylline is approximately three times that of caffeine
    C. theophylline has a more reliable enteral absorption than caffeine
    A. metabolism of both drugs takes place in the liver
    (this multiple choice question has been scrambled)
  63. When comparing chloral hydrate, midazolam and diazepam for use as a sedative, the nurse should recognize that
    A. chloral hydrate has the shortest half-life
    B. all three drugs provide some analgesic effect
    C. diazepam increases the risk of kernicterus
    C. diazepam increases the risk of kernicterus
    (this multiple choice question has been scrambled)
  64. When caring for a neonate who is receiving methylxanthines
    A. increase C02 responsiveness when administered at recommended doses
    B. stimulate the inhibitory effects of adenosine on respiratory function
    C. act primarily on brainstem respiratory function
    C. act primarily on brainstem respiratory function
    (this multiple choice question has been scrambled)
  65. A neonate is receiving hydrochlorothiazide PO every 12 hours. The nurse should understand that the pharmacologic response is
    A. commonly enhanced because of poor renal tubular absorption
    B. dependent on the existing level of renal function
    C. contingent on reaching the lumen of the distal tubule to achieve diuresis
    B. dependent on the existing level of renal function
    (this multiple choice question has been scrambled)
  66. The length of a drug's half-life is influenced by
    A. dosage of the drug given
    B. glomerular filtration rate
    C. volume of distribution
    C. volume of distribution
    (this multiple choice question has been scrambled)
  67. A neonate is easily overstimulated and cannot tolerate most handling. In planning care for this infant, the nurse should
    A. cluster procedures together to allow for longer rest periods
    B. provide containment for the infant during procedures
    C. stroke the infant to calm and soothe before procedures
    B. provide containment for the infant during procedures
    (this multiple choice question has been scrambled)
  68. Kangaroo care is initated for a 34 week gestational age infant. The nurse can anticipate that such care can
    A. improve physiologic self-regulation
    B. precipitate temperature instability
    C. increase the risk of apneic episodes
    A. improve physiologic self-regulation
    (this multiple choice question has been scrambled)
  69. A neonate who has been in the NICU for two weeks is demonstrating habituation in response to environmental stimuli. Habituation is best defined as
    A. decreasing responsivity to external stimuli
    B. reacting vigorously to repeating stimuli
    C. increasing attention to a new stimulus
    A. decreasing responsivity to external stimulus
    (this multiple choice question has been scrambled)
  70. A 35 week gestational age neonate with respiratory distress syndrome can suck and swallow a small amount of milk but then loses the swallow rhythm. Respiratory difficulty follows, and the neonate stops feeding. This is most likely due to
    A. underdeveloped self-regulation behaviors
    B. tongue thrusting movements
    C. an immature suck/swallow reflex
    A. underdeveloped self-regulation behaviors
    (this multiple choice question has been scrambled)
  71. A mother asks why blanket rolls are placed around her premature infant. The nurse should advise that this is done to
    A. minimize environmental noise
    B. conserve the infant
    C. prevent injury
    B. conserve the infant
    (this multiple choice question has been scrambled)
  72. The pattern of care provided to a neonate should be based on
    A. performing procedures and interventions on a regular routine schedule allowing for adequate rest periods
    B. initiation of aversive procedures during the quiet alert state to improve tolerance
    C. the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it
    C. the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it
    (this multiple choice question has been scrambled)
  73. The nurse should recognize that the auditory sounds of the NICU can compromise a neonate's neurobehavioral development and that most noise is produced by
    A. equipment
    B. exogenous sources
    C. staff
    C. staff
    (this multiple choice question has been scrambled)
  74. A mother has overheard a discussion that her preterm neonate is to have a Brazelton assessment. She asks what this examination entails. The nurse's best response is that Brazelton assessment assists in
    A. determining the differential maturity of infants
    B. evaluating the interactive behavior of the newborn
    C. confirming gestational age based on socialization abilities
    B. evaluating the interactive behavior of the newborn
    (this multiple choice question has been scrambled)
  75. A preterm neonate who has been in the neonatal intensive care unit for several months has just been weaned from a ventilator. The parents live several hundred miles away and have not been able to visit the unit on a regular basis. The mother picks up the infant, and the infant starts squirming and recoils from the mother's touch. The nurse should counsel the mother that these behaviors reflect
    A. detachment due to multiple care givers
    B. a lack of bonding between mother and child
    C. the infant's association of touch with pain
    C. the infant's association of touch with pain
    (this multiple choice question has been scrambled)
  76. A one week old neonate born at 33 weeks gestation often engages in foot or leg bracing when stimulated. These behaviors are most consistent with
    A. overstimulation or stress
    B. pain responses
    C. self-regulating behaviors
    C. self-regulating behaviors
    (this multiple choice question has been scrambled)
  77. Strategies for preventing diaper dermatitis include
    A. maintaining acidic skin pH
    B. removing skin barrier products at each diaper change
    C. keeping the skin moist
    A. maintaining acidic skin pH
    (this multiple choice question has been scrambled)
  78. When a skin excoriation occurs, the nurse should first
    A. cover the area with a transparent adhesive dressing
    B. clean the area and apply antibacterial ointment
    C. identify the cause of the injury
    C. identify the cause of the injury
    (this multiple choice question has been scrambled)
  79. To minimize skin trauma in the preterm neonate when removing adhesive tape, the nurse should use
    A. hydrocarbon solvents
    B. pectin barriers
    C. alcohol pledgets
    B. pectin barriers
    (this multiple choice question has been scrambled)
  80. Most research studies regarding the use of soaps, lubricants and antimicrobial skin solutions in premature infants conclude
    A. soaps including mild ones are potential irritants
    B. Providone-iodine is a safe agent for surgical skin preparation
    C. use of emollients does not improve skin integrity
    A. soaps including mild ones are potential irritants
    (this multiple choice question has been scrambled)
  81. A neonate born at 41 weeks gestation remains cyanotic despite oxygen administration. A soft systolic murmur can be heard on auscultation. The infant is tachypneic without respiratory distress. A chest x-ray reveals a normal size heart with decreased pulmonary vascularity. These findings are consistent with
    A. pulmonary atresia
    B. atrial septal defect
    C. coarctation of the aorta
    A. pulmonary atresia
    (this multiple choice question has been scrambled)
  82. The potent stimulant of smooth muscle contraction that is essential for ductus arteriosus closure is increased
    A. oxygen tension
    B. pulmonary vascular resistance
    C. circulating prostaglandins
    A. oxygen tension
    (this multiple choice question has been scrambled)
  83. A two day old neonate presents wih signs of congestive heart failuare, including a hyperdynamic precordium and hepatomegaly. Other significant findings include a cranial bruit and systolic ejection murmur. These physical findings are consistent with
    A. arteriovenous malformation
    B. cor pulmonale
    C. total anomalous pulmonary venous connection
    A. arteriovenous malformation
    (this multiple choice question has been scrambled)
  84. Ventricular septal defect should additionally be suspected in the neonate with transposition of the great arteries if
    A. a pronounced murmur is heard
    B. the heart is boot shaped
    C. cyanosis is present
    A. pronounced murmur is heard
    (this multiple choice question has been scrambled)
  85. Cardiovascular function is modulated by feedback to the autonomic nervous system from baroreceptors and chemoreceptors in the
    A. sinoatrial node
    B. aorta and carotid sinus
    C. ventricular myocardium
    B. aorta and carotid sinus
    (this multiple choice question has been scrambled)
  86. The best fetal screening procedure for a family with a history of cogenital heart disease is a/an
    A. doppler flow study
    B. echocardiogram
    C. four chamber ultrasound
    C. four chamber ultrasound
    (this multiple choice question has been scrambled)
  87. Most neonates with a small ventricular septal defect present with
    A. central cyanosis
    B. minimal left-to-right shunting
    C. congestive heart failure
    B. minimal left-to-right shunting
    (this multiple choice question has been scrambled)
  88. For the neonate with patent ductus arteriosus the left-to-right shunt is dependent on a decrease in
    A. systemic vascular resistance
    B. pulmonary artery pressure
    C. pulmonary vascular resistance
    C. pulmonary vascular resistance
    (this multiple choice question has been scrambled)
  89. The first clinical sign that appears in the neonate with congenital heart disease that reflects development of pulmonary edema is
    A. tachypnea
    B. cyanosis
    C. dyspnea
    A. tachypnea
    (this multiple choice question has been scrambled)
  90. The effectiveness of nitric oxide as a treatment for pulmonary hypertension is dependent on
    A. pulmonary ventilation-perfusion ratio
    B. recruitment of adequate lung volume
    C. the extent of right-to-left shunting
    B. recruitment of adequate lung volume
    (this multiple choice question has been scrambled)
  91. General guidelines for surfactant replacement therapy include which of the following?
    A. Prophylactic administration should occur within 1 hour after the onset of assisted ventilation
    B. indications for use include all preterm infants equal to or less than 32 weeks gestation with mild RDS requiring at least 40% Fi02
    C. Administration of surfactant by bolus injection is superior to slow injection
    C. Administration of surfactant by bolus injection is superior to slow injection
    (this multiple choice question has been scrambled)
  92. The diagnostic tool most helpful in differentiating pneumonia from other neonatal respiratory problems is
    A. chest x-ray
    B. tracheal aspirate
    C. sepsis work-up
    A. chest x-ray
    (this multiple choice question has been scrambled)
  93. A neonate with microcephaly, short stature and absent thumbs develops thrombocytopenia and elevated MCV at 1 month of age. Which of the following hematologic disorders is suspected?
    A. Blackfan-Diamond anemia
    B. Kasabach-Merritt syndrome
    C. Fanconi anemia
    C. Fanconi anemia
    (this multiple choice question has been scrambled)
  94. Patients with respiratoy distress syndrome exhibit a rapid and shallow breathing pattern. This is due to the work required to
    A. overcome the negative intrapleural pressure generated by contraction of the diaphragm and the respiratory muscles
    B. overcome motion caused by lung tissue movement and gas flow through the airways
    C. stretch the lungs and chest wall during a tidal respiration
    A. overcome the negative intrapleural pressure generated by contraction of the diaphragm and the respiratory muscles
    (this multiple choice question has been scrambled)
  95. Following treatment of respiratory distress syndrome in premature infants with surfactant therapy, the anticipated improvement in oxygenation can be attributed to
    A. enhanced matching of ventilation and perfusion
    B. lower surface tension
    C. improved lung compliance
    A. enhanced matching of ventilation and perfusion
    (this multiple choice question has been scrambled)
  96. A newborn with respiratory distress has a chest x-ray that reveals unilateral or bilateral streaky densities and confluent mottled, opacified areas. The nurse should anticipate that initial intervention should be
    A. culture of endotracheal tube aspirate
    B. initiation of antibiotics
    C. surfactant administration
    A. culture of endotracheal tube aspirate
    (this multiple choice question has been scrambled)
  97. The diffuse opacification seen on the chest x-ray of a neonate with respiratory distress syndrome primarily reflects
    A. pulmonary edema
    B. alveolar atelectasis
    C. interstitial emphysema
    A. pulmonary edema
    (this multiple choice question has been scrambled)
  98. Intervention directed at reducing the risk of pneumothorax for a premature infant with respiratory distress syndrome includes
    A. use of conventional mechanical ventilation
    B. monitoring of oxygen saturation
    C. positioning and securing the endotracheal tube
    C. positioning and securing the endotracheal tube
    (this multiple choice question has been scrambled)
  99. Research studies regarding the use of chest physiotherapy have found that
    A. it is a well documented process as established by both medical and nursing research
    B. more study is needed to determine its benefits and disadvantages
    C. its hazards clearly outweigh any of its potential benefits
    B. more study is needed to determine its benefits and disadvantages
    (this multiple choice question has been scrambled)
  100. The most useful way to differentiate between respiratory and non-respiratory disease in the neonate is
    A. arterial blood gas
    B. shunt study
    C. chest x-ray
    C. chest x-ray
    (this multiple choice question has been scrambled)
  101. A shunt study is performed on a neonate with respiratory distress, and the Pa02 does not change after 100% oxygen was administered. Based on this finding, it can be assumed that
    A. right-to-left shunting is present
    B. continuous positive airway pressure will be helpful
    C. the neonate has severe lung disease
    A. right-to-left shunting is present
    (this multiple choice question has been scrambled)
  102. A neonate has respiratory distress without cyanosis. The nurse should recognize that
    A. the hyperoxia test is used to rule out congenital heart disease
    B. cardiac lesions with poor systemic output cause respiratory distress
    C. cardiac defects with decreased pulmonary blood flow result in respiratory distress
    B. cardiac lesions with poor systemic output cause respiratory distress
    (this multiple choice question has been scrambled)
  103. Transient tachypnea of the newborn is defined as what type of lung disease
    A. obstructive
    B. restrictive
    C. inflammatory
    A. obstructive
    (this multiple choice question has been scrambled)
  104. After placement of a chest tube 24 hours ago, the nurse notes fluctuation of the fluid in the tube. The nurse should recognize that
    A. tube position needs to be reassessed
    B. gentle kneading of the tube is indicated
    C. this indicates the tube is patent and functional
    C. this indicates the tube is patent and functional
    (this multiple choice question has been scrambled)
  105. A factor that differentiates the pathophysiology between meconium ileus and meconium plug syndrome is the presence of
    A. bilious vomiting
    B. intestinal obstruction
    C. enzymatic deficiency
    C. enzymatic deficiency
    (this multiple choice question has been scrambled)
  106. A characteristic that is present in both omphalocele and gastroschisis is
    A. high incidence of congenital malformations
    B.malrotation of the intestine
    C. peritoneal sac covering the defect
    B. malrotation of the intestine
    (this multiple choice question has been scrambled)
  107. Absence of the ileocecal valve in the neonate with short bowel syndrome can lead to
    A. watery or fatty diarrhea
    B. dehydration and eletrolyte disturbance
    C. overgrowth of bacteria in the small intestine
    C. overgrowth of bacteria in the small intestine
    (this multiple choice question has been scrambled)
  108. Hirschsprung's disease occurs due to
    A. ganglion cell deficiency
    B. abnormal gut motility
    C. enzyme deficiency
    A. ganglion cell deficiency
    (this multiple choice question has been scrambled)
  109. The x-ray of a neonate with suspected necrotizing enterocolitis shows pneumoperitoneum. This finding is consistent wih
    A. bowel perforation
    B. diffuse gaseous intestinal distention
    C. air in the portal venous system
    A. bowel perforation
    (this multiple choice question has been scrambled)
  110. A 3 day old neonate has hematuria, decreased urine output and platelet count of 60,000. Which of the following is the most likely diagnosis?
    A. renal vein thrombosis
    B. renal tubular acidosis
    C. renal parenchymal disease
    A. renal vein thrombosis
    (this multiple choice question has been scrambled)
  111. A 32 week gestational age male neonate has a 4 cm nontender mass in the right groin. The initial step for differential diagnosis is
    A. ultrasound evaluation
    B. transillumination
    C. palpation
    C. palpation
    (this multiple choice question has been scrambled)
  112. The most important factor in the pathogenesis of neonatal renal vein thrombosis is
    A. mesenchymal developmental arrest
    B. obstruction of the urinary tract
    C. birth asphyxia
    C. birth asphyxia
    (this multiple choice question has been scrambled)
  113. The pathogensis of congenital adrenal hyperplasia includes
    A. deficiency of a 5-a-reductase required for conversion of testosterone to DHT
    B. conversion of progesterone to cortisol and aldosterone is prevented
    C. reduced negative-feedback regulation causes a decrease in ACTH
    B. conversion of progesterone to cortisol and aldosterone is prevented
    (this multiple choice question has been scrambled)
  114. Hypochloremia may occur secondary to diminished intake or increased loss of chloride. clinical manifestations include
    A. hyponatremia
    B. hyperkalemia
    C. metabolic alkalosis
    C. metabolic alkalosis
    (this multiple choice question has been scrambled)
  115. When a parent is to donate blood to their neonate for a blood transufusion, it is imperative that
    A. parental blood components be irradiated before use
    B. maternal blood donation be limited to plasma
    C. the father be eliminated as a donor if the mother has cytotoxic antibodies
    A. parental blood components be irradiated before use
    (this multiple choice question has been scrambled)
  116. A neonate born at 31 weeks gestation has coagulation studies performed and the following results are obtained: PTT: moderately prolonged; PT: severly prolonged; TT: mildly moderately prolonged; FIB: Decreased; D-Dimer: Positive; Platelets: Decreased. These findings are consistent with
    A. liver disease
    B. vitamin k deficiency
    C. disseminated intravascular coagulation
    A. liver disease
    (this multiple choice question has been scrambled)
  117. A neonate a few hours after birth develops patchy areas of skin thrombosis over the chest and buttocks. The painful lesions are palpable and dark red, changing to purple and black. This neonate requires administration of fresh frozen plasma and
    A. administration of vitamin K
    B. initiation of erythropoietin therapy
    C. replacement of proteins C or S
    C. replacement of proteins C or S
    (this multiple choice question has been scrambled)
  118. The primary therapy for disseminated intravascular coagulation consists of
    A. treatment of the underlying disorder
    B. heparin administration
    C. infusion of fresh frozen plasma
    A. treatment of the underlying disorder
    (this multiple choice question has been scrambled)
  119. Anemia of prematurity is characterized by a low reticulocyte count and
    A. abnormal erythroid maturation
    B. compromised bone marrow production
    C. inadequate response to erythropoietin
    C. inadequate response to erythropoietin
    (this multiple choice question has been scrambled)
  120. A three day old neonate with heart failure and pulmonary edema shows bloody frothy fluid from the trachea. This is consistent with
    A.pulmonary hemorrhage
    B. plural effusions
    C. pulmonary interstitial emphysema
    A. pulmonary hemorrhage
    (this multiple choice question has been scrambled)
  121. Initial management of a four day old breastfed infant with hyperbilirubinemia would include
    A. supplementation of breastfeeding with glucose water
    B. initiation of phototherapy
    C. increasing breastfeeding to 12 feedings per day
    C. increasing breastfeeding to 12 feedings per day
    (this multiple choice question has been scrambled)
  122. The efficacy of phototherapy depends on
    A. adequate hydration of the infant
    B. irradiance in the blue spectrum of the lights
    C. amount of time the infant is exposed to phototherapy lights
    B. irradiance in the blue spectrum of the lights
    (this multiple choice question has been scrambled)
  123. Which of the following is a true statement regarding neonatal hyperbilirubinemia
    A. newborn infants produce more bilirubin per day than adults
    B. infants with GI obstruction develop hyperbilirubinemia due to action of glucuronyl transferase
    C. newly synthesized unconjugated bilirubin is fat soluble
    C. newly synthesized unconjugated bilirubin is fat soluble
    (this multiple choice question has been scrambled)
  124. A cranial suture line of a neonate reveals an immovable bony prominence which is even and smooth bilaterally. This neonate should be evaluated for
    A. increased intracranial pressure
    B. seizure activity
    C. a linear skull fracture
    A. increased intracranial pressure
    (this multiple choice question has been scrambled)
  125. An increase in cerebral blood flow can be expected in association with
    A. increased pH
    B. decreased PaC02
    C. decreased K+
    B. decreased Pa02
    (this multiple choice question has been scrambled)
  126. The neuropathologic consequences of the germinal matrix and intraventricular hemorrhage include
    A. dilation of germinal matrix
    B. aqueductal stenosis
    C. infarction of periventricular white matter
    C. infarction of periventricular white matter
    (this multiple choice question has been scrambled)
  127. Hemorrhagic disease of the newborn is attributed to a deficiency of vitamin K-dependent factors. Additional predisposing characteristics include
    A. precipitous labor
    B. administration of antenatal steriods
    C. breastfeeding
    C. breastfeeding
    (this multiple choice question has been scrambled)
  128. A preterm infant of a diabetic mother has experienced several seizures. The most important action that needs to be taken with this neonate is to
    A. identify underlying cause of the seizures
    B. obtain an EEG to determine prognosis
    C. introduce prophylactic anticonvulsant medication
    A. identify underlying cause of the seizures
    (this multiple choice question has been scrambled)
  129. A neonate post-surgery for necrotizing enterocolitis 48 hours ago is on a ventilator. The neonate is grimacing and eyes are tightly shut. The heart rate is increased and the neonate is breathing over the ventilator. The most appropriate intervention would be to obtain an order for
    A. arterial blood gas to assess ventilatory satus
    B. sedation to calm infant
    C. pain medication
    C. pain medication
    (this multiple choice question has been scrambled)
  130. Macrocephaly commonly occurs with which of the following disorders of brain formation
    A. Prader-Willi syndrome
    B. Holoprosencephaly
    C. Dandy-Walker syndrome
    C. Dandy-Walker syndrome
    (this multiple choice question has been scrambled)
  131. Thymus-derived (T) cells are important in
    A. production of antibodies
    B. delayed hypersensitivity reactions
    C. secretion of immunoglobulins
    B. delayed hypersensitivity reactions
    (this multiple choice question has been scrambled)
  132. A female neonate was delivered at 28 weeks gestation. The amniotic fluid was meconium stained. Physicial examination shows a papular erthematous skin rash and enlarged liver. Tone is poor and the infant has had several episodes of apnea. Infection is suspected. The organism most likely responsible for this neonate's symptoms is
    A. group B streptococcus
    B. escherichia coli
    C. listerial monocytogenes
    C. listerial monocytogenes
    (this multiple choice question has been scrambled)
  133. A woman adequately treated for syphilis during pregnancy delivers an asymptomatic infant. Appropriate managment of the neonate should include
    A. serologic evaluation at 1, 2, 3, 6 and 12 months of age
    B. VDRL testing and a single dose of aqueous penicillin G
    C. lumbar puncture for cerebrospinal fluid analysis
    A. serologic evaluation 1, 2, 3, 6 and 12 months of age
    (this multiple choice question has been scrambled)
  134. Perinatal transmission of HIV infection is increased when the mother has
    A. low CD4 + lymphocyte count
    B. low bone marrow derived lymphocytes
    C. positive PCR assay
    A. low CD4 + lymphocyte count
    (this multiple choice question has been scrambled)
  135. Assessment of a term neonate is as follows: IUGR, microcephaly, congenital cataracts, hepatosplenomegaly, jaundice. Based on these findings, the most likely diagnosis is congenital
    A. syphilis
    B. cytomegalovirus
    C. rubella
    B. cytomegalovirus
    (this multiple choice question has been scrambled)
  136. A six day old neonate develops eyelid swelling with a purulent discharge. Gram negative intracellular diplococci are identified on gram stain. This conjunctivitis is caused by
    A. gonorrhea
    B. chlamydia
    C. herpes
    A. gonorrhea
    (this multiple choice question has been scrambled)
  137. In comparing neonates with early and late onset of Group B streptococcal infection, the nurse should recognize that
    A. meningitis is the most common complication in both groups of infants
    B. mortality rates are the same for both groups of infants
    C. ampicillin and gentamicin are most effective antibiotics for treatment
    A. meningitis is the most common complication in both groups of infants
    (this multiple choice question has been scrambled)
  138. A neonate born to a mother treated for premature labor with magnesium sulfate has a magnesium level of 4.8 mg/dL. This neonate should be managed wih
    A. calcium infusion
    B. administration of phosphorus
    C. supportive care
    C. supportive care
    (this multiple choice question has been scrambled)
  139. A neonate has a low T4 and elevated TSH on two consecutive newborn screening tests. The appropriate next step would be
    A. monitor the infant for lethargy, hypotonia and feeding difficulties
    B. recheck T4 and TSH levels at two months of age
    C. immediate thyroid hormone replacement therapy
    C. immediate thyroid hormone replacement therapy
    (this multiple choice question has been scrambled)
  140. An increased incidence of low serum calcium levels occurs in neonates who
    A. have a history of asphyxia
    B. are dehydrated
    C. have adrenal insufficiency
    A. have a history of asphyxia
    (this multiple choice question has been scrambled)
  141. A clinical indicator of the neonatal response to pain or stress is
    A. decrease in PC02
    B. release of growth hormone
    C. lower cortisol levels
    B. release of growth hormone
    (this multiple choice question has been scrambled)
  142. An umbilical artery catheter was inserted in the delivary room during resuscitation of a 34 week gestation female neonate. In caring for this infant, the nurse should recognize
    A. heparin use in flush solution will help decrease fisk of catheter occlusions
    B. addition of heparin to the infusate does not decrease the risk of aortic thrombus
    C. low placement of the UAC decreases the risk of vascular accident
    C. low placement of the UAC decreases the risk of vascular accident
    (this multiple choice question has been scrambled)
  143. Infants of diabetic mothers are at increased risk for hypoglycemia because of persistent insulin action and
    a. a lack of circulating glucagon levels
    b. abnormalities in glucose metabolism c. peripheral glucose uptake
    c. peripheral glucose uptake
  144. A predisposing factor to osteopenia of prematurity is
    A. diminished calcium absorption
    B. prolonged parenteral nutrition
    C. vitamin D deficiency
    B. prolonged parental nutrition
    (this multiple choice question has been scrambled)
  145. A two week old full term infant who has been hospitalized since birth due to surgery for intestinal obstruction presents with scaly skin and areas of desquamation. There are areas of irritation and oozing in the neck, groin, and perianal region. These symptoms are most likely caused by
    A. acrodermatitis enteropathica
    B. ichthyosis vulgaris
    C. essential fatty aicd deficiency
    C. essential fatty acid deficiency
    (this multiple choice question has been scrambled)
  146. Which of the following is a characteristic of an autosomal recessive disorder
    A. it is expressed in the heterozygous state
    B. parents are phenotypically normal
    C. there is 50% risk for each offspring to inherit the gene
    B. parents are phenotypically normal
    (this multiple choice question has been scrambled)
  147. A characteristic that is common to trisomy 13, trisomy 18 and trisomy 21 is that these neonates commonly have
    A.hand or finger abnormalities
    B. micrognathia
    C. eye malformations
    A. hand or finger abnormalities
    (this multiple choice question has been scrambled)
  148. Characteristics of bilateral multicystic dysplastic kidneys include
    A. normal ureters
    B. obstruction at the ureteropelvic junction
    C. predilection for males
    B. obstruction at the ureteropelvic junction
    (this multiple choice question has been scrambled)
  149. The scanning modality of choice to evaluate the anatomy of the obstructing tissue in choanal atresia is
    A. computerized tomography
    B. x-ray
    C. ultrasound
    A. computerized tomography
    (this multiple choice question has been scrambled)
  150. Nasal septum dislocation can be differentiated from normal variant of a misshappened nose by performing
    A. x-ray
    B. sinus transillumination
    C. a compression test
    C. a compression test
    (this multiple choice question has been scrambled)
  151. On examination of the newborn head, the nurse palpates the margin of parietal and occipital regions along the lamboidal suture and feels a ping-pong effect over the area. This finding is indicative of
    A. molding
    B. craniotabes
    C. craniosynostosis
    B. carniotabes
    (this multiple choice question has been scrambled)
  152. A term neonate who was born to an HBsAg positive mother is being discharged two months after birth following surgery for a cardiac condition. The mother asks when the next hepatitis B immunization should be given. The nurse should advise that it should be given
    A. in six months
    B. at the same time the measles-mumps-rubella vaccinations are given
    C. in four months
    B. at the same time the measles-mumps-rubella vaccinations are given
    (this multiple choice question has been scrambled)
  153. Concerning administration of immunizations to hospitalized preterm infants, the nurse should be aware that
    A. measles-mumps-rubella vaccine should not be given
    B. doses are lower than for term infants
    C. vaccines given at birth count as the initial dose
    A. measles-mumps-rubella vaccine should not be given
    (this multiple choice question has been scrambled)
  154. The timing of discharge of a preterm neonate born at 31 weeks gestation is based on
    A. meeting a weight criterion of at least five pounds
    B. physiologic stability and family resources for care
    C. attainment of a postnatal age of 40 weeks gestation
    B. physiologic stability and family resources for care
    (this multiple choice question has been scrambled)
  155. The parents of a four year old daughter must tell her that her newborn baby sister has died. Considering the cognitive understanding child, they should
    A. not let the child see the parents are upset
    B. explain the situation without using the word
    C. provide opportunites for repetitive explanations
    C. provide opportunites for repetitive explanations
    (this multiple choice question has been scrambled)
  156. Symptoms of grief and depression are very similar following neonatal loss. Specific symptoms that suggest referral to a mental health professional is indicated include
    A. guilt unrelated to the infant
    B. lack of motivation
    C. fatigue
    A. guilt unrelated to the infant
    (this multiple choice question has been scrambled)
  157. A mother is given her premature sick neonate to hold for the first time. She gently holds the infant using primarily finger touching interaction. The nurse should recognize that
    A. this mother needs time to gain confidence that her touching is not hurting the infant
    B. she may need to role model the mother on how to hold the infant
    C. this may be a sign that maternal-infant attachment is not occuring
    A. this mother needs time to gain confidence that her touching is not hurting the infant
    (this multiple choice question has been scrambled)
  158. When giving medical information to parents of a premature sick infant, information should be presented
    A. in a hopeful scenario focusing on the positives of the situation
    B. directly and honestly but using an individualized balanced approach
    C. cautiously because the infant's outcome is unknown
    B. directly and honestly but using an individualized balanced approach
    (this multiple choice question has been scrambled)
  159. In research, an instrument that is able to otain consistent results is termed
    A. valid
    B. reliable
    C. generalizable
    B. reliable
    (this multiple choice question has been scrambled)
  160. A theory that purports that moral rightness of an act must be made totally separate from the consequence of the action is called
    A. best interest
    B. deontology
    C. double effect
    B. deontology
    (this multiple choice question has been scrambled)

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