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N I C U Exam
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1. Physiologic jaundice is characterized by:
a) A rise in serum bilirubin to 7.5 mg/100mls by the fourth day after birth with a gradual decrease to concentrations of 1.5 mg/100 mls by the tenth day-increased indirect bilirubin
b) Visible jaundice before 48 hours of age
c) Associated ABO incompatibility - increased direct bilirubin
d) palpation
2. Pathologic jaundice within the first 36 hours of birth may be caused by:
a. Hemolytic disease; polycthemia; genetic disorders
b) Polycthemia-hemolytic disease;genetic disorders; pre-natal infection
c) Genetic disorders; hemolytic disease; pre-natal infection; post natal infection
d) Hemolytic disease; biliary artresia; edema
3. Which type of bilirubin is lipid soluble and may cross the blood-brain barrier into the basal ganglia:
a) Unconjugated
b)Conjugated
c)Direct
d) Indirect
4. Treatment of hyper-bilirubinemia may include all of the following EXCEPT:
a) Phototherapy
b) Exchange transfusion
c) Administration of phenobarbital
d) Administration of washed cells
5.(a) CASE PROBLEM- Baby Stork is full term and Mrs Storks first baby. She is eager to breastfeed. The physician orders no supplemental oral feeding. At 24 hours of age the baby shows visible jaundice. At 48 hours total serum bilirubin is 13 mgs/100
5. What might be the cause of this jaundice:
a) Delay in meconium passage
b) An elevation of serum non-esterified fatty acids
c) The presence of enzyme inhibitors in the breast milk
d) Dehydration
6. How might this case be managed:
a) IV infusion of glucose - photothereapy
b)Give frequent breast feedings - 10 to 12 times per day
c) Supplementation of breast milk - IV glucose infusion
d) IV infusion of glucose - exchange transfusion
7. Nursing management of the infant under phototherapy lights includes all the following EXCEPT:
a) Accurate recording of intake and output
b) Keeping infant covered if necessary to maintain stable temperature
c) Keeping eyes covered
d) Doing a serum bilirubin level at regular intervals - usually daily
8. Baby Sara - full term infant - has a serum bilirubin level of 20 mg/ml. The neo-natologist orders an exchange transfusion. Throughout the procedure it is essential that metabolic acidosis and cardiac arrest be prevented. Of the following which is MO
a) Observe vital signs every five minutes
b) Recording blood volume exchanged - amount withdrawn and infused
c) Closely monitoring body temperature and immediately attending to the baby's thermo regulation needs
d) Observe for excessive bleeding at umbilical catheter site
9.(a) CASE PROBLEM 9 thru 13- Baby Wally is a 26 week gestation - 1100 gram infant on the ventilator in the special care nursery. Maternal labor and delivery records reveal Mom is an 18 year old primigravida who went into labor and delivered via C-sect
9. You expect a medical diagnosis of:
a) Respiratory distress syndrome
b) Pneumonia
c) Hypoglycemia
d) Fetal alcohol syndrome
10. At 24 hours of age a head sonogram revealed a grade II Intraventricular hemorrhage. What pathophysiology is present:
a) Rupture of the subependymal veins
b) Rupture of the subependymal veins-extravasation of the hemorrhage out of the subependymal region
c) Extravassation of the hemorrhage out of the subependymal region - dilatation of the ventricle - death of brain tissue
d) Blocked ventricle; veins; extravasation of the hemorrhage out of the subependymal region
11. What is the prognosis for this infant:
a) Resolution of the hemorrhage or worsening of the hemorrhage
b) Worsening of the hemorrhage - profound mental and physical handicap
c) Ventilator dependence
12(a). At 8 days of age-ventilator support increased-gastric residuals increased-abdominal distention occurred-blood pressure decreased 10 mm Hg and the baby appeared lethargic:
12. Nursing interventions might include all EXCEPT:
a) Making the infant NPO until physician is notified
b) Ordering stat abdominal X-rays
c) Monitoring intake and output
d) Neurological system assessment of activity level- head circumference; measuring abdominal circumference
13. After careful consideration and further clinical evaluation-the physician ordered Baby Wally MPO - a repeat head sonogram- chest and abdominal X-rays- CBC and blood culture- electrolytes and glucose. Medical diagnoses he may be considering include:
a) Necrotizing enterocolitis - sepsis
b) Perforated ileus
c) Resolving IVH - Hyperglycemia
d) Necrotizing entercololitis - sepis - resolving IVH - Hyperglycemia
14. The MOST FREQUENT indication for oxygen administration in the newborn is:
a. Respiratory distress syndrome
b) Apnea
c) Cyanosis
d) Asphyxia
15. Of the following nursing responsibilities in the care of an infant receiving oxygen therapy - WHICH contributes MOST to prophylaxis of complications:
a) Carefully recording all data
b) Vital signs monitored every 30 minutes to one hour
c) Concentration analysis and arterial oxygen tension monitoring
d) Frequent suctioning of the edotracheal tube with small French catheter
16. Respiratory distress is characterized by all of the following EXCEPT:
a) Tachypnea
b) Nasal flaring
c) Grunting - retractions - cyanosis
d) Seizures
17. Signs and symptoms of respiratory distress may be caused by all of the following EXCEPT:
a) Hypothermia
b) Sepsis
c) Leukopenia
d) Seizures
18. Condition characterized by cyanosis - tachypnea - grunting and nasal flaring often present sudden change in respiratory status - unequal breath sounds auscultated; shift of apical pulse and chest expansion is asymmetrical:
a) Respiratory distress syndrome
b) Pneumothorax
c) Bronchopulmonary dysplasia
d) Apnea
19. Condition in which an infant has expiratory grunting or whining when the infant is NOT crying; sternal and intercostal retractions - nasal flaring - cyanosis in room air; chest X-ray shows reticulogranular - ground glass appearance with air bronchogra
a) Aspiration pneumonia
b) Status asthmatic
c) Respiratory Distress Syndrome
d) Tracheal-Laryngeal Dysplasia
20. Disease caused by prolonged- high - oxygen therapy and mechanical ventilation with high pressure and an end tracheal tube thaqt disrupts normal mucociliary function- infant usually starts out with respiratory distress syndrome:
a) Tracheal Esophageal dysplasia
b) Bronchopulmnary dysplasia
c) Alveolar fibrosis
d) Hyaline membrane disease
21. Cessation of breathing for 15-30 seconds; functional changes may occur such as cyanosis- hypotonia- or metabolic acidosis is:
a) Apnea
b) Cheyne-Stokes
c) Respiratory distress syndrome
d) Functional Apnea
22. Arterial blood gases reflect all of the following EXCEPT:
a) Pulmonary status of the newborn
b) Cardiac status of the newborn
c) Metabolic status of the newborn
d) Neurological status of the newborn
23. Petechiae and a severely depressed platelet count in an otherwise healthy appearing neonate is most likely due to:
a) Vitamin K deficiency
b) Congenital disease of the bone marrow with impairment of the platelet production
c) A transplacentally acquired antibody produced by the mother which attacks the platelets of the infant
d) Viral infection acquired in utero
24(a) CASE PROBLEM- Mrs. B- Gravida V- Para IV- delivered a term- 1 and one half pound male infant in her car on the way to the hospital. Ambulance attendants transported both of them to the hospital. In the nursery- because of the birth circumstance-
24. Other factors which may contribute to Vitamin K deficiency include all of the following EXCEPT:
a) Antibiotic administration for a prolonged time
b) Breastfeeding
c) Malabsorption syndrome
d) Sepsis
25. Two of the MOST COMMON organisms causing neonatal septicemia are:
a) Pseudomonas aeruginosa - E. coli
b) E. coli serratia marcescens
c) E. coli- Group B Beta hemolytic strep
d) Group B Beta hemolytic strep - pseudomonas aeruginosa
26. Clinical signs and symptoms of sepsis include all BUT WHICH of the following:
a) Lethargy
b) Apnea
c)Temperature instability
d) Depressed fontanels
27. Risk factors for neonatal sepsis include ALL of the following EXCEPT:
a) Prolonged rupture of amnniotic membranes; prolonged labor
b) Maternal urinary tract infection - maternal fever
c) Immersion in warm water just after delivery as in LeBoyer method
d) Admission into a special care nursery
28. Which of the following statements is NOT TRUE concerning neonatal meningitis:
a) It is the most common infection of the CNS in infants and children
b) It can be caused by various organisms- including bacteria and viruses-however- fungi and parasites are the most common
c) Generalized sepsis often accompanies meningitis
d) Requires prompt diagnosis and treatment for survival of the infant
29. A baby wet with amniotic fluid loses heat by:
a) Evaporation
b) Conduction
c) Convection
d) Radiation
30. An uncovered baby in an open crib loses heat by:
a) Evaporation
b) Conduction
c) Convection
d) Radiation
31. A baby weighed on a cold scale loses heat by:
a) Evaporation
b) Conduction
c) Convection
d) Radiation
32. A baby in an isolette placed directly under an air-conditioning vent loses heat by:
a) Evaporation
b) Conduction
c) Convection
d) Radiation
33. Clinical signs of hypothermia include all BUT which one of the following:
a) Hypotonia
b) Shallow respirations
c)) Refusal to suck
d) Increased crying
34. Consequences of hypothermia include:
a. Hyperglycemia - metabolic acidosis
b) Metabolic acidosis - hypoglycemia
c) Pulmonary vasodilatation
d) Depressed production of norepinephrine
35. The neutral thermal environment is one in which:
a) The infant must constantly increase metabolic demnads to stay warm
b) The infant is covered with blankets
c) The infant maintains a body temperature of 36.5-37 C in an environment in which caloric expenditure and oxygen use is minimal
d) The infant's body temperature remains constant
36. Infants can maintain their body temperature by all of the following EXCEPT:
a) Shivering
b) Vsoconstriction
c) Utilizing brown fat
d) Burning glucose
37. What is the BEST method for preventing the spreading of infections among neonates:
a) Maintaining a space of 3 feet around each isolette
b) Wearing a mask
c) Strict handwashing
d) Reading the Infection Control Manual
38. Head circumference may be inaccurate when:
a) Taken from brow to occiput
b) Taken from brow to parietal area
c) Repeated 3 times and averaged
d) Measuring in inches
39. Bulging - tight fontanelles:
a) Are normally found in pre-term infants
b) Indicate probable intrauterine growth retardation
c) Indicate neurological distress
d) Indicates a large amount of brain tissue
40. Which of these is NOT a symptom of hypoglycemia:
a) Restlessness
b) Weak suck
c) Passing of meconium stool
d) Apnea
41. Bio-chemical resuscitation of the newborn may include all BUT which of the following:
a) Sodium bicarbonate 4.2 percent - 1-2mEg IV push
b) Calcium chloride 1.3cc/kg IV push
c) Epinephrine 1:10000 0.1cc/kg IV push
d) Calcium gluconate 1-2cc/kg IV push
42. Sarah is an infant with a congenital cardiac defect. Sarah's mother plans to come for the mid-morning feeding. When planning your teaching strategies for helping Sarah's mom - the BEST thing to tell her is:
a. Be persistent - it may take Sarah 45 minutes to 1 hour to eat
b) Give Sarah a bath first - this will wake her up and get her blood flowing
c) Feed Sarah small frequent feedings which last no longer than 20 to 25 minutes
d) Wait 4 or 5 hours between feedings so Sarah will be really hungry - she will eat a lot better
43. Hypoglycemia in the pre-term infant is indicated by:
a) Levels below 30-35 mg/100ml during the first 72 hours after birth
b) Levels below 20 mg/100ml
c) Levels below 40 mg/ml during first 24 hours after birth
44. The MOST important steps in any resuscitation include:
a. Adequate ventilation and oxygenation to correct acidosis
b) Adequate oxygenation to correct cyanosis - immediate cardiac massage
c) Immediate cardiac massage and adequate ventilation
d) Administration of emergency drugs to correct acidosis and prevent increased serum K levels
45. An UNDESIRABLE side effect of Theophylline in neonates is:
a) Low systemic blood pressure
b) Tachpnea
c) Tachycardia
d) Bradycardia
46. Which of the following provides the BEST method for taking frequent neonates temperatures:
a) Rectal temperature
b) Gluteal fold temperature
c) Axillary temperature
d) Forehead temperature
47. Which of the following contributes MOST to decreasing the incidence of neonatal apnea:
a) Caffeine injections
b) Auditory stimulation
c) Tactile stimulation
d) Suctioning
48. Intermittent gavage feedings are indicated for infants less than 32 weeks gestation. All of the following statements are TRUE concerning gavage feedings EXCEPT:
a) The 15 inch size 5 to 8 feeding tube is secured between feedings to prevent dislodging
b) The amount of initial feeding is determined by the infants weight
c) Stomach contents are aspirated prior to each feeding and residual fluid is recorded and replaced as part of the feeding
d) Pssage of the tube can precipitate changes in heart rate and blood pressure in response to vagal stimulation
49. Which of the following BEST describes the etiology of enterocolitis:
a) It is precipitated by invasion of the bowel by Beta Hemolytic Streptococcus
b) It often results from inactivity of the bowel during hyperalimentation when the intestinal mucosa undergoes atrophic changes
c) It results from increased pressure within the intestine following invasion of mucosa with gas forming bacteria
d) It occurs in infants who gastronintestional tract has suffered a vascular compromise related to shunting of blood from the mesentery to a hypoxic vital organ
50. Although definitive diagnosis is established by laboratory and X-ray examination - EARLY subtle signs which indicate possible sepsis in the neonate are:
a) Vomiting; temperature of 100 degrees F
b) Poor thermoregulation - poor feeding
c) Jaundice - edema
d) Tachycardia - pallor