Neonatology

Question 1

In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a:
Question 1 options:

A)

meningomyelocele.

B)

Tetralogy of Fallot.

C)

choanal atresia.

D)

omphalocele.

Answer 1

meningomyelocele

Question 2

Which of the following best describes Pierre Robin syndrome?
Question 2 options:

A)

Repeat febrile seizures within the first 6 months of life

B)

Persistent pneumonia following meconium aspiration

C)

A congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate

D)

A condition in which the ductus arteriosis fails to close completely

Answer 2

a congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate

Question 3

Which of the following is TRUE regarding vaginal delivery?
Question 3 options:

A)

The compression of the infant’s chest during vaginal delivery aids in the removal of fluid from the fetal lungs.

B)

Infants delivered vaginally are at greater risk of post-delivery complications.

C)

Vaginal delivery stimulates the production of insulin in the newborn.

D)

The foramen ovale close more successfully in newborns delivered vaginally.

Answer 3

the compression of the infants chest during vaginal delivery aids in the removal of fluids from the fetal lungs

Question 4

Factors that stimulate the newborn to take the first breath include all of the following EXCEPT:
Question 4 options:

A)

hypothermia.

B)

hyperglycemia.

C)

hypoxia.

D)

acidosis.

Answer 4

hyperglycemia

Question 5

You are caring for a newborn who had prolonged respiratory distress and hypoxia following birth. You recognize that continued hypoxia and subsequent severe acidosis can cause:
Question 5 options:

A)

persistent fetal circulation.

B)

the formation of congenital heart defects.

C)

refractory hypotension.

D)

rapid development of fetal alveoli to compensate for hypoxia.

Answer 5

persistent fetal circulation

Question 6

You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action?
Question 6 options:

A)

Contact medical control to order acetaminophen.

B)

Reassure the parents that the infant’s sleep patterns and temperature are normal.

C)

Undress the infant to his diaper and sponge him with tepid water.

D)

Administer a 10 mL/kg fluid bolus.

Answer 6

reassure the parents that the infants sleep patterns and temperature are normal

Question 7

You have just assisted in the delivery of a full-term infant in the back of the ambulance. Ten minutes after delivery, you obtain vital signs on the newborn and find the following: heart rate 120, respirations 54, and SpO2 of 90%. You recognize:
Question 7 options:

A)

the need for immediate supplemental oxygen.

B)

tachycardia and the possibility of shock.

C)

appropriate vital signs for this infant.

D)

tachypnea and possible respiratory distress.

Answer 7

tachycardia and the possibility of shock

Question 8

Which of the following is NOT an option for prehospital vascular access in the newborn?
Question 8 options:

A)

Cannulation of a peripheral vein in an extremity

B)

Femoral vein cannulation

C)

Umbilical vein cannulation

D)

Intraosseous needle placed in the proximal tibia

Answer 8

femoral vein cannulation

Question 9

Which of the following is NOT a recommended method for assessing the heart rate of a newborn?
Question 9 options:

A)

Palpate the umbilical pulse

B)

Palpating the carotid pulse

C)

Palpate a femoral pulse

D)

Auscultate heart sounds

Answer 9

palpating the carotid pulse

Question 10

Which of the following statements is TRUE regarding the cardiac output of a neonate?
Question 10 options:

A)

Cardiac output doubles within the first few hours of life.

B)

Newborns have a fixed stroke volume; cardiac output depends mostly on heart rate.

C)

Neonates do not readily alter their pulse rate; cardiac output depends mainly on stroke volume.

D)

The cardiac output of a neonate is strongly influenced by body temperature.

Answer 10

newborns have a fixed stroke volume; cardiac output depends mostly on heart rate

Question 11

A newborn has just been delivered. You notice a greenish-brown substance on the infant, and observe a vigorous cry and active movement. What is the appropriate way to manage this patient?
Question 11 options:

A)

Rub the infant with a dry towel and place on the mother’s chest.

B)

Lay the infant supine and place padding behind the shoulders.

C)

Using a bulb syringe, suction the nose and then the mouth.

D)

Prepare to suction the trachea with an endotracheal tube and meconium aspirator.

Answer 11

rub the infant with a dry towel and place on the mothers chest

Question 12

At 90 seconds after birth, based on the following findings, which newborn does NOT require resuscitative efforts beyond routine care?
Question 12 options:

A)

HR = 98, RR = 27, peripheral cyanosis, APGAR = 6

B)

HR = 75, RR = 25, central cyanosis, APGAR = 5

C)

HR = 100, RR = 30, peripheral cyanosis, APGAR = 8

D)

HR = 158, RR = 40, central cyanosis, APGAR = 6

Answer 12

HR 100, RR 30 , peripheral cyanosis, APGAR 8

Question 13

You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. After 30 seconds of drying and stimulation, the infant remains limp and cyanotic, with a pulse of 50. Which of the following is the most appropriate action to take at this point?
Question 13 options:

A)

Intubate the trachea, ventilate, reassess, and prepare to transport to a NICU.

B)

Begin bag-valve-mask ventilations and establish intravenous access.

C)

Begin CPR at a rate of 3 compressions to 1 ventilation.

D)

Continue to warm and dry the infant for an additional 30 seconds, while preparing to intubate.

Answer 13

begin CPR at a rate of 3 compressions to 1 ventilation

Question 14

Immediately after delivery, a neonate is crying and moving his arms and legs, but is centrally cyanotic. You recognize:
Question 14 options:

A)

the need to prevent further heat loss.

B)

signs of a congenital heart abnormality.

C)

signs of a normal, healthy infant.

D)

the need for supplemental oxygen.

Answer 14

signs of a normal healthy infant

Question 15

All of the following are accurate methods for obtaining the heart rate of a newborn EXCEPT:
Question 15 options:

A)

a pulse oximeter.

B)

3-lead ECG.

C)

auscultating heart tones.

D)

palpating a brachial pulse.

Answer 15

palpating a brachial pulse

Question 16

You are resuscitating a 15-day-old infant who was found pulseless and apneic in her crib. Which of the following questions would be most helpful when obtaining a history from the parents?
Question 16 options:

A)

“Have any of your other children died from SIDS?”

B)

“Is there a family history of heart disease?”

C)

“Was your baby sleeping face up?”

D)

“Does your daughter have any congenital heart abnormalities?”

Answer 16

does your daughter have any congenital heart abnormalities

Question 17

You are called to the home of a 72-hour-old infant whose mother is concerned because the infant has been “vomiting after she eats.” Based on this information, which of the following should you include in your history and physical assessment?
Question 17 options:

A)

Assessing the fontanels

B)

End-tidal CO2 monitoring

C)

Asking if the baby could have ingested any toxins

D)

Auscultation of gastric sounds

Answer 17

assessing the fontanels

Question 18

You have just assisted in the delivery of an approximately 4 kg newborn whose mother is a rather petite primapara. On assessment, you note that there is no spontaneous movement of the infant’s right arm at the shoulder, but he moves the elbow and wrist. He otherwise exhibits vigorous movement and has a 1-minute APGAR score of 9. Which of the following should you suspect?
Question 18 options:

A)

Spinal cord damage

B)

Fractured clavicle

C)

Caput succedaneum

D)

Neonatal abstinence syndrome

Answer 18

fractured clavicle

Question 19

You are assessing a 1-minute APGAR score on a patient who has peripheral cyanosis and a heart rate of 98, who cried spontaneously after delivery, is actively moving his extremities, and has a strong cry. What is the APGAR score of this patient?
Question 19 options:

A)

9

B)

8

C)

10

D)

7

Answer 19

8

Question 20

A newborn was found pulseless and apneic in his crib. After lengthy attempts at resuscitation, medical control has advised you to stop resuscitation. When you inform the parents, they become hysterical and the mother cries, “Give me my baby! I don’t want you touching him!” You should:
Question 20 options:

A)

request that a law enforcement officer remain with the mother.

B)

gently tell the mother that, unfortunately, she cannot hold the baby until the coroner arrives.

C)

move the infant to the ambulance and transport.

D)

hand the child to the mother and allow the parents time alone with the child.

Answer 20

hand the child to the mother and allow the parents time alone with the child

Question 21

You are called to a residence to care for a 3-hour-old infant in respiratory distress. Your physical exam reveals retractions, grunting, and tachypnea, along with rhonchi and crackles in the lungs. The midwife reports that the amniotic fluid had “thin meconium.” Which of the following is the most likely cause of this infant’s signs and symptoms?
Question 21 options:

A)

Persistent fetal circulation

B)

Cardiac compromise

C)

Tetralogy of Fallot

D)

Meconium aspiration

Answer 21

meconium aspiration

Question 22

You respond to an apartment for a “sick child.” You arrive to find a 2-week-old infant in her mother’s arms, wrapped in a thick blanket. The mother reports that the baby has been coughing, and suddenly “went stiff” 10 minutes ago. The infant is listless and not rousable. You should FIRST:
Question 22 options:

A)

unwrap the child and assess skin temperature.

B)

package the infant in a car seat and transport emergently.

C)

obtain a blood pressure and medical history.

D)

apply oxygen and assess blood glucose.

Answer 22

unwrap the child and assess skin temperature

Question 23

Which of the following is NOT a consequence of respiratory insufficiency in the newborn?
Question 23 options:

A)

Hyperglycemia

B)

Acidosis

C)

Bradycardia

D)

Hypoxia

Answer 23

hyperglycemia

Question 24

A first-time mother has called 911 because her 5-day-old son is “acting sick.” Your assessment reveals a lethargic infant with a patent airway, adequate respirations, and a pulse rate of 100 beats per minute. His skin is cold to the touch and mottled. The mother reports she was giving the child a bath just prior to calling EMS. You suspect:
Question 24 options:

A)

hyperglycemia.

B)

hypoxia.

C)

hypercarbia.

D)

hypothermia.

Answer 24

hypothermia

Question 25

A 4-hour-old infant is inconsolable with a weak cry. His hands and feet are trembling. The mother reports a history of gestational diabetes and hypertension, and states she delivered at home without complication. Which of the following is the most likely cause of this infant’s signs and symptoms?
Question 25 options:

A)

Type 1 diabetes mellitus

B)

Meconium aspiration

C)

Hypoglycemia

D)

Febrile seizures

Answer 25

hypoglycemia

Question 26

Which of the following is the correct dosage of epinephrine in neonatal resuscitation?
Question 26 options:

A)

0.1 to 0.3 mg/kg, 1:1,000

B)

0.01 to 0.03 mg/kg, 1:10,000

C)

1 to 3 mg/kg, 1:10,000

D)

0.01 to 0.03 mg/kg, 1:1,000

Answer 26

0.01 to 0.03 mg/kg 1:1000

Question 27

Which of the following statements is TRUE of prehospital newborn care?
Question 27 options:

A)

Sixty percent of newborns delivered outside a hospital require some form of resuscitation.

B)

Low-birth-weight babies are much more likely to require immediate assistance after delivery.

C)

It is impossible to anticipate which deliveries may result in the need for newborn resuscitation.

D)

Newborns weighing over 2,500 grams are at higher risk of respiratory compromise.

Answer 27

low birth weight babies are more likely to require immediate assistance after delivery

Question 28

Which of the following statements BEST describes the relationship between primary and secondary apnea in newborns?
Question 28 options:

A)

Secondary apnea is a less serious condition and responds well to tactile stimulation and an oxygen-enriched atmosphere.

B)

Secondary apnea results from primary apnea.

C)

Primary apnea occurs only at birth, whereas secondary apnea occurs anytime during the first month of life.

D)

Primary apnea is due to respiratory failure, whereas secondary apnea is due to cardiac arrhythmia.

Answer 28

secondary apnea results from primary apnea

Question 29

The appearance of your newborn patient leads you to suspect that he has Pierre Robin syndrome. Which of the following should be your most immediate concern?
Question 29 options:

A)

Lower airway obstruction

B)

Upper airway obstruction

C)

Shunting of blood through a patent foramen ovale

D)

Compression of the lungs by the abdominal contents

Answer 29

upper airway obstruction

Question 30

You suspect that a newborn has choanal atresia. Which of the following signs would lead you to this diagnosis?
Question 30 options:

A)

The infant develops cyanosis when crying.

B)

The baby has unequal brachial pulses.

C)

The infant has a persistently low SpO2.

D)

The baby cannot nurse and breathe at the same time.

Answer 30

the baby can not nurse and breathe at the same time

Question 31

Which of the following conditions may result in persistent fetal circulation?
Question 31 options:

A)

Down syndrome

B)

Hypoxia

C)

Failure to cut the umbilical cord

D)

Overaggressive administration of blow-by oxygen

Answer 31

hypoxia

Question 32

Which of the following are likely to occur when suctioning a newborn’s airway?
Question 32 options:

A)

Vagal stimulation, tachycardia

B)

Hypoxia, ventricular fibrillation

C)

Hypoxia, bradycardia

D)

Hypoxia, tachycardia

Answer 32

hypoxia bradycardia

Question 33

Which of the following describes the appropriate administration of intravenous fluids in a newborn?
Question 33 options:

A)

5 percent dextrose in 0.45 percent saline solution, 30 mL/kg

B)

Normal saline, 10 mL/kg, slow IV push

C)

Normal saline or lactated Ringer’s solution 40 mL/kg using a pressure infuser

D)

10 percent dextrose in water, 20 mL/kg, slow IV push

Answer 33

normal saline, 10mg/kg slow IV push

Question 34

Which of the following BEST describes why hypoglycemia after delivery is common in infants born to mothers with gestational diabetes?
Question 34 options:

A)

Gestational diabetes may cause fetal pancreatic abnormalities that cause hypoglycemia after birth.

B)

The genetic nature of diabetes mellitus makes infants born to mothers with gestational diabetes more likely to have diabetes themselves.

C)

The fetus is no longer receiving insulin via the umbilical cord, and therefore becomes hypoglycemic after birth.

D)

The fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery.

Answer 34

the fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery

Question 35

Which of the following is the appropriate way to document a premature infant’s gestational age?
Question 35 options:

A)

“Infant was born 3 weeks early.”

B)

“Infant’s gestational age is 4 weeks premature.”

C)

“Infant was born 3 weeks prior to due date.”

D)

“Infant was born at 33 weeks and 4 days gestation.”

Answer 35

infant was born at 33 weeks and 4 days gestation

Question 36

In which of the congenital anomalies of the heart does the ductus arteriosus fail to close?
Question 36 options:

A)

tetralogy of Fallot

B)

transposition of the great vessels

C)

patent ductus arteriosus

D)

ventricular septal defect

Answer 36

patent ductus arteriosus

Question 37

In which of the congenital anomalies of the heart is there a narrowing in the arch of the aorta, obstructing blood flow?
Question 37 options:

A)

coarctation of the aorta

B)

aortic stenosis

C)

mitral stenosis

D)

hypoplastic left heart syndrome

Answer 37

coarctation of the aorta