Deck 3: Neonatology

Question 1

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?

A) Prepare to suction the trachea with an endotracheal tube and meconium aspirator.
B) Using a bulb syringe, suction the nose and then the mouth.
C) Rub the infant with a dry towel and place on the mother's chest.
D) Lay the infant supine and place padding behind the shoulders.

Answer 1

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

Question 2

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:

A) gently tell the mother that, unfortunately, she cannot hold the baby until the coroner arrives.
B) hand the child to the mother and allow the parents time alone with the child.
C) request that a law enforcement officer remain with the mother.
D) move the infant to the ambulance and transport.

Answer 2

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

Question 3

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?

A) Administer a 10 mL/kg fluid bolus.
B) Undress the infant to his diaper and sponge him with tepid water.
C) Reassure the parents that the infant's sleep patterns and temperature are normal.
D) Contact medical control to order acetaminophen.

Answer 3

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

Question 4

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

A) a pulse oximeter.
B) 3-lead ECG.
C) palpating a brachial pulse.
D) auscultating heart tones.

Question 5

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

A) the need for supplemental oxygen.
B) signs of a normal, healthy infant.
C) the need to prevent further heat loss.
D) signs of a congenital heart abnormality.

Question 6

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?

A) 9
B) 7
C) 8
D)10

Question 7

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?

A) End-tidal CO₂ monitoring
B) Auscultation of gastric sounds
C) Asking if the baby could have ingested any toxins
D) Assessing the fontanels

Question 8

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:

A) refractory hypotension.
B) rapid development of fetal alveoli to compensate for hypoxia.
C) persistent fetal circulation.
D) the formation of congenital heart defects.

Question 9

Which of the following best describes Pierre Robin syndrome?

A) A congenital condition characterized by a small jaw and large tongue in conjunction with a cleft palate
B) A condition in which the ductus arteriosis fails to close completely
C) Repeat febrile seizures within the first 6 months of life
D) Persistent pneumonia following meconium aspiration

Question 10

Which of the following statements is TRUE regarding the cardiac output of a neonate?

A) Cardiac output doubles within the first few hours of life.
B) The cardiac output of a neonate is strongly influenced by body temperature.
C) Neonates do not readily alter their pulse rate; cardiac output depends mainly on stroke volume.
D) Newborns have a fixed stroke volume; cardiac output depends mostly on heart rate.

Question 11

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:

A) the need for immediate supplemental oxygen.
B) appropriate vital signs for this infant.
C) tachycardia and the possibility of shock.
D) tachypnea and possible respiratory distress.

Question 12

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

A) HR = 100, RR = 30, peripheral cyanosis, APGAR = 8
B) HR = 158, RR = 40, central cyanosis, APGAR = 6
C) HR = 75, RR = 25, central cyanosis, APGAR = 5
D) HR = 98, RR = 27, peripheral cyanosis, APGAR = 6

Question 13

Which of the following is TRUE regarding vaginal delivery?

A) Infants delivered vaginally are at greater risk of post-delivery complications.
B) The compression of the infant's chest during vaginal delivery aids in the removal of fluid from the fetal lungs.
C) Vaginal delivery stimulates the production of insulin in the newborn.
D) The foramen ovale close more successfully in newborns delivered vaginally.

Question 14

Which of the following is NOT an option for prehospital vascular access in the newborn?

A) Cannulation of a peripheral vein in an extremity
B) Intraosseous needle placed in the proximal tibia
C) Femoral vein cannulation
D) Umbilical vein cannulation

Question 15

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

A) hypothermia.
B) hypoxia.
C) hyperglycemia.
D) acidosis.

Question 16

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?

A) Begin CPR at a rate of 3 compressions to 1 ventilation.
B) Intubate the trachea, ventilate, reassess, and prepare to transport to a NICU.
C) Begin bag-valve-mask ventilations and establish intravenous access.
D) Continue to warm and dry the infant for an additional 30 seconds, while preparing to intubate.

Question 17

Which of the following is NOT a recommended method for assessing the heart rate of a newborn?

A) Palpating the carotid pulse
B) Palpate the umbilical pulse
C) Auscultate heart sounds
D) Palpate a femoral pulse

Question 18

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

A) Tetralogy of Fallot.
B) meningomyelocele.
C) omphalocele.
D) choanal atresia.

Question 19

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?

A) Neonatal abstinence syndrome
B) Spinal cord damage
C) Fractured clavicle
D) Caput succedaneum

Question 20

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?

A) "Does your daughter have any congenital heart abnormalities?"
B) "Was your baby sleeping face up?"
C) "Is there a family history of heart disease?"
D) "Have any of your other children died from SIDS?"

Question 21

Which of the following conditions may result in persistent fetal circulation?

A) Failure to cut the umbilical cord
B) Down syndrome
C) Hypoxia
D) Overaggressive administration of blow-by oxygen

Question 22

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

A) Primary apnea is due to respiratory failure, whereas secondary apnea is due to cardiac arrhythmia.
B) Primary apnea occurs only at birth, whereas secondary apnea occurs anytime during the first month of life.
C) Secondary apnea results from primary apnea.
D) Secondary apnea is a less serious condition and responds well to tactile stimulation and an oxygen-enriched atmosphere.

Question 23

Which of the following describes the appropriate administration of intravenous fluids in a newborn?

A) Normal saline or lactated Ringer's solution 40 mL/kg using a pressure infuser
B) Normal saline, 10 mL/kg, slow IV push
C) 10 percent dextrose in water, 20 mL/kg, slow IV push
D) 5 percent dextrose in 0.45 percent saline solution, 30 mL/kg

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:

A) hypoxia.
B) hyperglycemia.
C) hypothermia.
D) hypercarbia.

Question 25

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

A) coarctation of the aorta
B) hypoplastic left heart syndrome
C) aortic stenosis
D) mitral stenosis

Question 26

Which of the following are likely to occur when suctioning a newborn's airway?

A) Hypoxia, tachycardia
B) Hypoxia, bradycardia
C) Hypoxia, ventricular fibrillation
D) Vagal stimulation, tachycardia

Question 27

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

A) The fetus develops compensatory insulin production in utero due to maternal hyperglycemia, which causes hypoglycemia after delivery.
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) Gestational diabetes may cause fetal pancreatic abnormalities that cause hypoglycemia after birth.

Question 28

Which of the following statements is TRUE of prehospital newborn care?

A) It is impossible to anticipate which deliveries may result in the need for newborn resuscitation.
B) Newborns weighing over 2,500 grams are at higher risk of respiratory compromise.
C) Sixty percent of newborns delivered outside a hospital require some form of resuscitation.
D) Low-birth-weight babies are much more likely to require immediate assistance after delivery.

Question 29

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?

A) Tetralogy of Fallot
B) Cardiac compromise
C) Persistent fetal circulation
D) Meconium aspiration

Question 30

Which of the following is NOT a consequence of respiratory insufficiency in the newborn?

A) Hypoxia
B) Hyperglycemia
C) Bradycardia
D) Acidosis

Question 31

Which of the following is the appropriate way to document a premature infant's gestational age?

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."

Question 32

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:

A) unwrap the child and assess skin temperature.
B) apply oxygen and assess blood glucose.
C) obtain a blood pressure and medical history.
D) package the infant in a car seat and transport emergently.

Question 33

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?

A) Type 1 diabetes mellitus
B) Meconium aspiration
C) Hypoglycemia
D) Febrile seizures

Question 34

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?

A) Upper airway obstruction
B) Lower airway obstruction
C) Compression of the lungs by the abdominal contents
D) Shunting of blood through a patent foramen ovale

Question 35

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

A) The infant develops cyanosis when crying.
B) The baby cannot nurse and breathe at the same time.
C) The baby has unequal brachial pulses.
D) The infant has a persistently low SpO₂.

Question 36

Which of the following is the correct dosage of epinephrine in neonatal resuscitation?

A) 0.1 to 0.3 mg/kg, 1:1,000
B) 0.01 to 0.03 mg/kg, 1:1,000
C) 0.01 to 0.03 mg/kg, 1:10,000
D) 1 to 3 mg/kg, 1:10,000

Question 37

In which of the congenital anomalies of the heart does the ductus arteriosus fail to close?

A) transposition of the great vessels
B) patent ductus arteriosus
C) ventricular septal defect
D) tetralogy of Fallot