CH 43

Question 1

Severely hypothermic newborns may present with sclerema, which is defined as:

• an inability to shiver due to an immature immune system.
• hardening of the skin associated with reddening and edema.
• spontaneous bleeding due to blood-clotting abnormalities.
• a yellow or orange tint to the white portion of the eyes.

Answer 1

hardening of the skin associated with reddening and edema.

Question 2

If you feel 13 pulsations in a 6-second time frame, the newborn’s heart rate is approximately:
130 beats/min.
60 beats/min.
30 beats/min.
90 beats/min.

Answer 2

130 bpm

Question 3

If a newborn does not respond to the initial steps of resuscitation, the need for further intervention is based upon:

• respiratory effort, pulse rate, and color.
• appearance, skin color, and muscle tone.
• pulse rate, activity, and appearance.
• respirations, appearance, and muscle tone.

Answer 3

respiratory effort, pulse rate, and color.

Question 4

If a newborn requires epinephrine and peripheral venous access is unsuccessful, you should:

• inject the drug directly into a vein.
• perform intubation immediately.
• cannulate the umbilical vein.
• defer drug therapy and transport.

Answer 4

cannulate the umbilical vein.

Question 5

You are transporting a newborn who requires ongoing ventilatory support and chest compressions for severe bradycardia. Your estimated time of arrival at the hospital is 45 minutes. Air medical transport was unavailable due to severe weather. A peripheral IV line has been established in the antecubital vein, and you are in the process of attempting intubation. Approximately 10 seconds into your intubation attempt, the newborn’s heart rate suddenly drops more. You should:

• continue the intubation attempt and administer atropine.
• abort the intubation attempt and continue ventilations.
• administer 0.1 to 0.3 mL/kg of epinephrine via rapid IV push.
• ensure that chest compressions are of adequate rate and depth.

Answer 5

abort the intubation attempt and continue ventilations.

Question 6

When performing chest compressions on a newborn, you should:

• deliver 120 compressions and 40 ventilations during any 60-second period.
• reassess the newborn’s heart rate after every 60 seconds of compressions.
• use the two-finger compression technique if two rescuers are present.
• compress the chest one-third the anteroposterior depth of the chest.

Answer 6

compress the chest one-third the anteroposterior depth of the chest.

Question 7

You have just delivered a baby boy who was born 4 weeks premature. There is no evidence of meconium in the amniotic fluid. After drying, warming, suctioning, positioning, and stimulating the infant, he remains acrocyanotic and is not crying. You should:

begin assisting his ventilations at once.
resuction his mouth for up to 10 seconds.
open his airway and assess respirations.
determine the newborn’s Apgar score.

Answer 7

open his airway and assess respirations.

Question 8

Which of the following is a sign of a diaphragmatic hernia?

Scaphoid or concave abdomen
Presence of a tracheoesophageal fistula
Bilaterally absent breath sounds
Metabolic acidosis

Answer 8

Scaphoid or concave abdomen

Question 9

What is the combined Apgar score for a newborn with a heart rate of 80 beats/min and slow, irregular breathing?
3
5
2
4

Answer 9

2

Question 10

Compared to subsequent breaths, the first few positive-pressure breaths delivered to a distressed newborn:

• should provide a volume equal to 40 to 45 mm Hg.
• should make the chest rise significantly.
• may necessitate manual disabling the pop-off valve.
• generally require a significantly lower volume of air.

Answer 10

may necessitate manual disabling the pop-off valve

Question 11

If hypovolemia is suspected or confirmed, you should administer how many milliliters of normal saline to a 6-pound newborn over a period of 5 to 10 minutes?
27 mL
55 mL
18 mL
33 mL

Answer 11

27 mL

Question 12

Which of the following factors is associated with the highest risk of newborn hypoglycemia?

• Neonatal polycythemia
• The larger of discordant twins
• Morbid obesity in the mother
• 5-minute Apgar score of less than 7

Answer 12

Morbid obesity in the mother

Question 13

The most common reasons for ineffective bag-mask ventilations in the newborn are:

• pneumothorax and a face mask that is too large for the infant.
• inadequate mask-to-face seal and incorrect head position.
• equipment malfunction and a ventilation rate that is too rapid.
• hyperflexion of the newborn’s head and thick mucous plugs

Answer 13

inadequate mask-to-face seal and incorrect head position.

Question 14

Chest compressions are indicated in the newborn if the heart rate remains less than how many beats/min despite effective positive-pressure ventilations for 30 seconds?
90 beats/min
60 beats/min
80 beats/min
70 beats/min

Answer 14

60 beats/min.

Question 15

After inserting an orogastric tube in a newborn, you should:

• connect the tube to continuous suction.
• perform intubation within 2 minutes.
• leave the 20-mL syringe attached.
• leave the tube open to allow air to vent

Answer 15

leave the tube open to allow air to vent

Question 16

Which of the following events is a critical part of fetal transition?

• An acute increase in intrapulmonary pressure
• Fetal lung expansion within 5 minutes after birth
• Diversion of blood flow to the fetus’s lungs
• Blood flow diversion across the ductus arteriosus

Answer 16

Diversion of blood flow to the fetus’s lungs

Question 17

Naloxone is contraindicated for use in newborns:

• unless the umbilical vein has been cannulated.
• with shallow breathing and persistent bradycardia.
• who weigh less than 5.5 pounds.
• who are born to narcotic-addicted mothers

Answer 17

who are born to narcotic-addicted mothers

Question 18

What size and type of laryngoscope blade is recommended for use in a full-term newborn?
No. 1, curved
No. 1, straight
No. 2, curved
No. 2, straight

Answer 18

No. 1, straight

Question 19

Caput succedaneum is defined as:

• bilateral temporal bone fractures caused by a delivery that included the use of forceps.
• permanent cranial disfigurement caused by vaginal delivery in a woman with cephalopelvic disproportion.
• an area of bleeding between the parietal bone and its covering periosteum that resolves in 1 to 2 months.
• temporary swelling of the soft tissue of the baby’s scalp secondary to pressure from the dilating cervix.

Answer 19

temporary swelling of the soft tissue of the baby’s scalp secondary to pressure from the dilating cervix.

Question 20

Most newborns with hypoglycemia remain asymptomatic until the glucose level falls below how many milligrams per deciliter for a significant period of time?

40 mg/dL
45 mg/dL
20 mg/dL
30 mg/dL

Answer 20

20 mg/dL

Question 21

Tetralogy of Fallot is a combination of four heart defects, including:

• right ventricular hypertrophy.
• atrial septal defect.
• tricuspid atresia.
• coarctation of the aorta.

Answer 21

right ventricular hypertrophy.

Question 22

Which of the following statements regarding fever in the newborn is correct?

• Fever in newborns is defined as a rectal temperature greater than 99.0 degrees Fahrenheit.
• The ability of the newborn to dissipate heat through sweating is prominent.
• Because of their active immune systems, newborns commonly experience fever.
• Fever may not always be a presenting feature in newborns with an infection.

Answer 22

Fever may not always be a presenting feature in newborns with an infection.

Question 23

Your assessment of a depressed 7-pound newborn reveals tachypnea, pallor, weak peripheral pulses, a heart rate of 120 beats/min, and a blood glucose level of 58 mg/dL. Which of the following interventions will most likely cause improvement in this newborn’s condition?
Naloxone
Dextrose
Normal saline
Epinephrine

Answer 23

NS

Question 24

A subtle seizure in the newborn is characterized by:
repetitive jerking.
tonic limb extension.
eye deviations.
flexion of the arms.

Answer 24

eye deviations

Question 25

Respiratory distress in a premature infant is most often the result of: - pneumonia at birth. - intracranial hemorrhage. - a pneumothorax. - surfactant deficiency.

Answer 25

surfactant deficiency.

Question 26

You have been providing bag-mask ventilation to a newborn with a sustained heart rate of 75 beats/min for approximately 5 minutes. The infant's abdomen is markedly distended. Although you are properly trained, your protocols do not allow you to intubate newborns. The most appropriate intervention involves: - performing manual gastric decompression. - inserting an orogastric tube. - intubating immediately. - suctioning the oropharynx.

Answer 26

inserting an orogastric tube.

Question 27

Total anomalous pulmonary venous return is a rare congenital defect in which: - blood returns to the lungs after being reoxygenated. - venous blood mixes with arterial blood in the heart. - the four pulmonary veins connect to the right atrium. - pressure in the lungs causes pulmonary hypertension.

Answer 27

the four pulmonary veins connect to the right atrium.

Question 28

During the delivery of a post-term baby, you note the presence of particulate meconium in the amniotic fluid. Your post-delivery assessment reveals that the newborn is active, has a strong cry, and has a heart rate of 110 beats/min. You should: - deliver free-flow oxygen at 5 L/min while performing deep oropharyngeal suctioning with a bulb syringe aspirator. - preoxygenate the newborn with bag-mask ventilations for 30 seconds and then perform endotracheal intubation. - avoid any form of tactile stimulation, perform laryngoscopy, and suction meconium from the trachea with an endotracheal tube. - ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

Answer 28

ensure that the infant is warm and dry, administer free-flow oxygen if needed, and provide continuous monitoring.

Question 29

A newborn is at greatest risk for meconium aspiration if they: are large for their gestational age. are born at more than 42 weeks' gestation. require positive-pressure ventilations. have respiratory depression at the time of birth.

Answer 29

are born at more than 42 weeks' gestation.

Question 30

During your rapid assessment of a newborn's cardiopulmonary status, you note that the newborn's respirations are adequate, you feel 8 pulsations in a 6-second time frame, and the newborn is centrally pink but peripherally cyanotic. The most appropriate next action should be to: administer positive-pressure ventilations. assess the newborn's blood glucose level. provide 30 seconds of tactile stimulation. give free-flow oxygen by mask at 5 L/min.

Answer 30

administer positive-pressure ventilations.

Question 31

Causes of delayed fetal transition include: prenatal vitamins. acidosis. hypertension. birth at 41 weeks.

Answer 31

acidosis

Question 32

Choanal atresia is defined as a: - bony or membranous obstruction of the back of the nose. - condition in which high-flow oxygen causes blindness. - condition in which the occipital skull is abnormally large. - small chin that causes a posteriorly positioned tongue.

Answer 32

bony or membranous obstruction of the back of the nose.

Question 33

Which of the following are antepartum risk factors that increase the potential that a newborn may require resuscitation? Breech or abnormal presentation Polyhydramnios Use of opioids within 4 hours of delivery Prolapsed cord

Answer 33

Polyhydramnios

Question 34

Which of the following is a sign hypovolemia in the newborn? Persistent pallor High pulse rate Persistent acrocyanosis Strong pulses

Answer 34

persistent pallor

Question 35

The most common device used to provide positive-pressure ventilation to a newborn in the prehospital setting is a:  T-piece resuscitator. manually triggered ventilator. self-inflating bag-mask device. flow-inflating bag-mask device.

Answer 35

self-inflating bag-mask device.

Question 36

Mortality and morbidity are high among infants who are delivered at 24 weeks' gestation, usually because of: respiratory and neurologic problems. infection and hypothermia. metabolic and immune deficiencies. congenital heart defects.

Answer 36

respiratory and neurologic problems.

Question 37

Which of the following items is required for newborn resuscitation? Laryngeal mask airway Endotracheal tubes Cardiac monitor Pulse oximeter

Answer 37

Endotracheal tubes

Question 38

After performing the initial steps of resuscitation, you assess a newborn and note that their respirations are poor and their pulse rate is 50 beats/min. You should: - begin chest compressions, insert an endotracheal tube, and administer 0.1 to 0.3 mL/kg of epinephrine 1:10,000 down the endotracheal tube. - immediately begin positive-pressure ventilations and chest compressions and then reassess the newborn's pulse rate in 30 seconds. - begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation. - perform tactile stimulation for 30 seconds, reassess the infant's respirations and pulse rate, and begin positive-pressure ventilations if there is no improvement.

Answer 38

begin chest compressions if the heart rate remains below 60 beats/min after 30 seconds of effective positive-pressure ventilation.

Question 39

The quickest way to prevent newborn hypothermia involves: administering warmed, humidified oxygen. applying a hot water bottle to the groin area. thoroughly drying the newborn after birth. administering warmed IV fluids.

Answer 39

thoroughly drying the newborn after birth.

Question 40

A delay in clamping the umbilical cord and keeping the baby below the level of the placenta can result in fetal: polycythemia. anemia. hypovolemia. exsanguination.

Answer 40

polycythemia

Question 41

To assess a newborn's preductal oxygen saturation, you should place the pulse oximeter probe on the: left foot. right hand. right foot. left hand.

Answer 41

right hand

Question 42

In addition to an IV dextrose bolus, the most important treatment for newborn hypoglycemia is: • IV fluid boluses. • assisted ventilation. • a 25% dextrose infusion. • proper thermal management.

Answer 42

Proper thermal management.

Question 43

You and your partner are caring for a 5-pound distressed newborn. After providing 30 seconds of effective bag-mask ventilations, the newborn's heart rate remains below 60 beats/min. You should: • continue bag-mask ventilations and initiate chest compressions. • cannulate the umbilical vein and give 0.5 mL of epinephrine. • try tactile stimulation as you continue bag-mask ventilations. • start a peripheral IV line and give 4 mEq of sodium bicarbonate.

Answer 43

continue bag-mask ventilations and initiate chest compressions.

Question 44

The single most common cause of seizures in both term and preterm infants is: • intracranial hemorrhaging. • hypoxic–ischemic encephalopathy. • a severe derangement in electrolytes. • congenital or developmental defects.

Answer 44

hypoxic–ischemic encephalopathy.

Question 45

Which of the following disorders or conditions is related to decreased glycogen stores in the newborn? • Small for gestational age • Large for gestational age • Maternal diabetes mellitus • Hypoxia or hypothermia

Answer 45

Small for gestational age.