NRP Quiz Flashcards

1
Q

You have started positive-pressure ventilation for a newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation?

A

A rising heart rate

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2
Q

What is an indication for endotracheal intubation?

A

The need for positive pressure ventilation lasting more than a few minutes.

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3
Q

MR. SOPA helps your team correct problems with ventilation. What are the steps?

A

Adjust mask and Reposition head and neck; Suction mouth then nose and Open the mouth; increase Pressure; insert Alternative airway

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4
Q

What is the appropriate technique to stimulate a baby to breath?

A

Gently rub the baby’s back or extremites.

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5
Q

The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process?

A

Initiate positive pressure ventilation and check for increasing heart rate.

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6
Q

What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room?

A

Place a pulse oximeter on the baby’s right hand or wrist and assess oxygen saturation.

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7
Q

You are at the resuscitation of a newborn who is gasping and has a heart rate of 60bpm. What is the most important action you can take?

A

Provide positive-pressure ventilation

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8
Q

During the resuscitation of a newborn you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team?

A

100 beats per minute

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9
Q

What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps?

A

Administration of positive-pressure ventilation that inflates the lungs.

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10
Q

What are the initial steps of newborn care?

A

Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate.

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11
Q

What is the recommended practice when using a pulse oximeter in the delivery room?

A

Place the pulse oximeter sensor on the right hand or wrist and use the minute specific oxygen saturation target to guide oxygen supplementation.

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12
Q

What is a normal transitional physiology at the time of birth (as pertains to oxygen saturation)?

A

Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.

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13
Q

What size endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)?

A

2.5mm

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14
Q

You are uncertain whether you have successfully intubated a newborn. What diagnostic can be used to confirm placement?

A

CO2 detector indicates the presence of expired CO2

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15
Q

You attend to a baby post emergency cesarean delivery, who is term as expected, with very poor tone and he is apneic. You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation?

A

Start positive-pressure ventilation and check heart rate response after 15 seconds

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16
Q

A newborn of 34 weeks’ gestation apneic at birth, does not respond to initial steps and requires positive-pressure ventilation. What concentration of oxygen should be used?

A

FiO2 of 21 - 30%

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17
Q

What is a critical characteristic in team leaders?

A

Maintain situational awareness.

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18
Q

You are part of a team preparing for the birth of a baby who has meconium-stained fluid and a category III fetal heart rate tracing. Who should you ensure is present at the birth?

A

A person skilled in endotracheal intubation

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19
Q

The steps of intubation should ideally be completed within which duration?

A

30 seconds

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20
Q

Four pre-birth questions should be asked to assess perinatal risk and determine who should be present at the birth. What are they?

A
  • What is the expected gestational age?
  • Is the amniotic fluid clear?
  • How many babies are expected?
  • Are there any additional risk factors?
21
Q

For every delivery, what is the minimum requirement for care of the newborn at birth?

A

Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn.

22
Q

A baby is born at 34 weeks’ gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps?

A

Initiate positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate.

23
Q

At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with his mother or be moved to the radiant warmer for further assessment?

A

Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying?

24
Q

A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated?

A

Insert a laryngeal mask

25
Q

You are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help?

A

Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.

26
Q

How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?

A

1 minute

27
Q

Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine?

A

The baby’s heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.

28
Q

Your team begins administering chest compressions to a newborn. Correct technique for compressions?

A

Thumbs remain in contact with the chest at all times.

29
Q

When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation?

A

The option of providing comfort care can be considered.

30
Q

What is the preferred method for assessing heart rate during chest compressions?

A

Electronic cardiac (ECG) monitoring

31
Q

Which ethical principle(s) guide the resuscitation of a newborn?

A

The approach to decisions in the newborn should be guided by the same principles used for adults and older children.

32
Q

A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?

A

Respirations, heart rate, oxygen saturation

33
Q

When are chest compressions indicated?

A

When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.

34
Q

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. What must be included in the baby’s subsequent care?

A

Monitor blood glucose levels because of the risk of hypoglycemia after birth.

35
Q

For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?

A

0.1 mL

36
Q

What may be associated with delayed cord clamping in vigorous preterm newborns?

A

Decreased need for blood transfusions

37
Q

A baby’s heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. What is a common cause of this type of asymmetric breath sounds in an intubated baby?

A

Endotracheal tube inserted too deep

38
Q

What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg?

A

1.5mL

39
Q

What time frame should be used to administer intravenous epinephrine?

A

Rapid push, as quickly as possible

40
Q

In preparation for the initial steps for a known very preterm birth, what should you have ready?

A

Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.

41
Q

During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen. She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side. What is the most likely cause of this distress?

A

Left-sided pneumothorax

42
Q

A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?

A

Stop chest compressions; continue positive-pressure ventilation.

43
Q

A baby born at 36 weeks’ gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. What should be checked soon after resusitation?

A

His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.

44
Q

After chest compressions with coordinated ventilations are started, when should the heart rate be assessed?

A

After 60 seconds

45
Q

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

A

The newborn’s parents

46
Q

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby is 5 minutes old and breathing spontaneously. The baby’s heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby’s respirations are labored. What is the next appropriate action?

A

Administer CPAP at 5 cm H20 pressure

47
Q

Why is it important to maintain appropriate body temperature in babies that suffered brain injury from decreased oxygen and blood flow to the brain (hypoxic-ischemic encephalopathy)?

A

A high body temperature (hyperthermia) may worsen neurologic outcomes.

48
Q

What does positive-pressure ventilation increases the risk of?

A

pneumothorax

49
Q

When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?

A

30 breaths, 90 compressions

1 and 2 and 3 and breath