Module 1 Practice Questions

Question 1

Blood travels from the placenta to the baby via the:

Answer 1

umbilical vein

Question 2

From the umbilical vein, blood travels through the:

Answer 2

ductus venosus

Question 3

From the ductus venosus blood travels on to the…

Answer 3

inferior vena cava

Question 4

From the inferior vena cava, blood flows into the

Answer 4

right atrium

Question 5

Blood flows from the right to left atrium via the:

Answer 5

foramen ovale

Question 6

Blood flows from the right ventricle to the pulmonary arteries. Only a small amount goes to the developing lungs, which have this type of resistance:

Answer 6

high pulmonary vascular resistance

Question 7

From the right ventricle, blood is shunted away through the ____________ and back to aorta.

Answer 7

ductus arteriosus

Question 8

The postpartum shift of increased ______ vascular resistance and decreased _____ vascular resistance causes the _____ to close.

Answer 8

Systemic, Pulmonary, ductus arteriosus

Question 9

When does fetal lung fluid clear?

Answer 9

A few days prior to birth
During labor
Postnatally

Question 10

Fetal systemic circulation is characterized by what type of pressure system?

Answer 10

Low

Question 11

With delayed cord clamping, blood flow from the newborn to the placenta will stop at what time?

Answer 11

Varies but typically within 5 minutes

Question 12

If the infant does not get enough oxygen after birth, the pulmonary vascular pressure will be:

Answer 12

High

Question 13

Neonatal systemic circulation is characterized by what type of pressure system?

Answer 13

High

Question 14

Following birth, what does the increased systemic pressure and decreased pulmonary pressure lead to in the left side of the heart?

Answer 14

Closure of the foramen ovale and ductus arteriosus (need to confirm answer with prof)

Question 15

What fetal circulatory complication can third-trimester ingestion of ibuprofen cause?

Answer 15

Closure of the ductus arteriosus

Question 16

How does the pulmonary vascular pressure change with the newborn’s initial breath?

Answer 16

Decreases

Question 17

What biochemical event stimulates newborn breathing?

Answer 17

Decreased oxygen and increased carbon dioxide

Question 18

Which pulmonary cells secret surfactant?

Answer 18

Type II alveolar cells

Question 19

The mother gives birth in the hands and knees position. As the baby’s head emerges, fluid begins to flow from the baby’s nose. How should the nurse-midwife manage this situation?

Answer 19

Recognize this as one of three ways lung fluid drains at birth

Question 20

Which vessels are considered vasoactive in fetal/newborn circulation, having the ability to constrict?

Answer 20

pulmonary artery
ductus arteriosus
umbilical artery

Note: only the arteries constrict!!

Question 21

What type of birth environment assists in preserving newborn brown adipose tissue (BAT)?

Answer 21

neutral thermal environment

Question 22

There are 4 mechanisms through which Newborns loose heat. In third-world countries where maternal mortality is high, the newborns may be placed aside after birth to see if the mother will survive. If placed directly on a cold table, what is the predominant heat loss mechanism?

Answer 22

Conduction

Question 23

What are the 5 stages of fetal lung development, and when do they occur?

Answer 23

Embryonic (1-7wk)
Pseudoglandular (5-17wk)
Canalicular (16-25)
Terminal sac (25-36wk)
Alveolar (36wk -8y)

Question 24

When does surfactant get produced and what is its purpose?

Answer 24

Starts being produced in canalicular phase of lung development (16-25w) hence why some of this stage is potentially viable.

After week 34, there is enough surfactant to keep the alveoli from collapsing.

It’s purpose: Lowers surface tension to prevent collapse on expiration

Question 25

What facilities the removal of fluid from the lungs in the days before birth?

Answer 25

ENaC - epithelial sodium channels - begin to clear alveolar fluid days before birth. The sodium pulls the water out of the lungs and ENaC causes the lungs to change from active fluid secretion to active fluid absorption.

Question 26

What could be some of the effects of a hypoxic newborn on breathing and circulation?

Answer 26

Low oxygen would cause pulmonary artery contraction and increased pulmonary vascular resistance, leading to primary and secondary apnea.

The increase PVR could prevent the ductus arteriosis from closing properly.

Question 27

What happens to the pulmonary arteries because of the first breath?

Answer 27

They dilate and lower the pulmonary vascular resistance. Resulting in closure of the ductus arteriosis

Question 28

Why could motrin cause the closure of the ductus arteriosus?

Answer 28

Because it is an antiprostaglandin

Question 29

What are the three ways baby’s create heat?

Answer 29

-Nonshivering thermogenesis
-Voluntary muscle activity
-Shivering

Question 30

Why would a premie not be able to regulate its own temperature as well as a full term baby?

Answer 30

Brown fat is deposited from 26-28w, a premie may not have this store built up. The baby may also not have the muscle strength or the glucose stores to warm itself.

Question 31

What response should the provider have to an asymptomatic cold baby with a temp of 97.4?

Answer 31

Skin to skin!

Question 32

What is the providers goal to assist baby with themoregulation?

Answer 32

A neutral thermal environment

Question 33

What should the provider be aware of with a baby that is hypothermic at 97.2 degrees and on skin to skin?

Answer 33

There is a risk of hypoglycemia if the temp drops much lower or stays low for an extended period of time.

Question 34

You are doing postpartum day 1 rounds on a mother and baby (17 hours old). The baby is being breastfed. You note yellowing skin and eyes and the mother states the baby has not been eating well. The billirubin screen shows 17 mg/dl. What should you tell the mother?

Answer 34

You are concerned for pathologic jaundice. The baby will begin phototherapy and you will refer to a pediatrician.

Question 35

You are doing postpartum day 3 rounds on a breastfed baby. You note yellowing skin and eyes and the mother states the baby has not been eating well. The billirubin screen shows 13 mg/dl. What should you tell the mother?

Answer 35

This type of jaundice is expected with breastfeeding babies that are not getting enough milk either through low supply or poor feeding. Lets discuss how to help you with this.

Question 36

You are doing a home visit on a patient who delivered 4 days ago. The mother has been formula feeding since delivery but has noticed the baby’s skin is “a little yellow” today. What should you tell her?

Answer 36

This is likely physiologic jaundice that we expect after a baby is born, but let’s test the babies bilirubin to be sure!

Question 37

A patient calls you that was delivered 6 days ago. She has been breast feeding since delivery. She is concerned that the baby’s skin is beginning to look “a little yellow” since this morning. What is the most likely type of jaundice?

Answer 37

Breast milk jaundice

Question 38

What is the normal range for neonatal hemoglobin?

Answer 38

HGB 14-20 g/L

Question 39

What is the normal range for neonatal hematocrit?

Answer 39

HCT 43-63%

Question 40

What is the normal range for neonatal WBC?

Answer 40

WBC 10, 000-30,000/mm3

Question 41

What is the normal range for neonatal platelets?

Answer 41

Platelets 150,000-400,000