Download CCRN-NICU QUESTIONS WITH ACCURATE ANSWERS and more Exams Medicine in PDF only on Docsity!
CCRN-NICU QUESTIONS WITH ACCURATE
ANSWERS
"Blueberry muffin" rash and hepatosplenomegaly are characteristic of which infection? correct answer Congenital CMV A 1 day old infant is noted to have a petechial rash over his scalp, face, and trunk. The nurse caring for this infant should anticipate an order to check the infant's: correct answer Platelets- diffuse petechial rash suggestive of thrombocytopenia A 1 month old infant born at 27 weeks gestation has developed two soft, raised, bright red tumors, one on the chest and one on the arm. These lesions have grown in size over the past 10 days when they were first noted. The mom asks the nurse if these lesions will continue to grow. The nurse's response is based off the knowledge that this type of lesion will: correct answer Grow for 6-12 months and then involute- can treat with oral or topical propanolol, however, not necessary for it to go away A 10-day old infant born at 34 wks by spontaneous vaginal delivery after 12 hours of ruptured membranes develops a vesicular rash over the occiput. In addition to culturing the lesion, the nurse should anticipate that this infant will require which of the following tests on an urgent basis? correct answer LP- performed in all suspected cases of neonatal herpes simplex virus A 2 day old full term male w/ a hx of low apgar scores, poor urine output, and hypertonicity was noted to have 2 episodes of apnea accompanied by lip smacking and eye deviations. Episodes are most likely: correct answer Subtle seizures- most common type of seizures in premature infants Benign familiar seizures present similarly but w/o hx of low apgar scores
Neonatal myoclonus manifests as episodes of repetitive jerking or jitteriness that does not stop with passive restraint Tonic-clonic include stiffening and repetitive jerking A 2 day old is noted to have significant jaundice. His blood work shows decreased hgb, hyperbili, and a positive direct antigen test. These findings are most likely a result of? correct answer Immune-mediated hemolysis A 2 week old premie neonate has vesiculopapular lesions with an erythematous baise in her groin. Small white pustules can be seen on the lower abdomen. The most likely cause of this rash is correct answer Candida albicans- common in groin with satellite lesions extending beyond the groin A 3 day old infant born after induction at 41 weeks has a birthweight of 4.2kg. The infant has course facial features, a large anterior fontanel with a normal HC, an umbilical hernia, and a hx of poor feeding. The infant should be assessed for? correct answer Congenital hypothyroidism- signs are not always obvious at birth, often diagnosed during routine newborn screening. Other signs include thick skin, delayed bone age, poor perfusion, and hypothermia. A 3.2 kg, 37 week infant is admitted to the NICU because of resp distress. The infant was a c-sec for maternal HTN, APGARS were 6 and 8. On admission, the RR is 80-90 w/ moderate indrawing and occasional grunting. A chest radiograph shows increased vascular markings with expansion of the chest to the tenth rib. This infant most likely has: correct answer TTN- more common in late preterm and term infants born by c-sec. CXRs w/ over-expansion, haziness, increased vascular markings, and fluid in the fissure A 32-week preterm newborn born at a community facility has a HR of 130 bpm. The newborn is breathing spontaneously, although it has moderate retractions.
A 4000-g male infant has just been delivered via c sec due to fetal distress. The infant is born through thick meconium and requires ET suctioning. At the initial assessment, the infant's skin is noted to be leathery, cracked, and wrinkled. The infant's scrotum is noted to be pendulous with the testes descended. The nurse assessing this infant can anticipate that this infant is: correct answer Postterm A 41 wk baby is delivered by c sec for failure to progress. The baby is LGA with head, length, and weight all at the 95th percentile. On exam, the baby is centrally pink with no resp distress and has good tone. There is no caput or molding of the head noted. However, on palpation several soft spots that recoil with pressure are noted over the back of the head. Most likely explanation? correct answer Craniotabes- soft spots on the skull that collapse and recoil with pressure. Usually found in parietal or occipital region and though to result from bone reabsorption due to the pressure of the skull against the maternal pelvis A gestational age exam has just been performed on a newborn infant. The infant was noted to be in flexed position. The assessment shows that the square window angle is 0 degrees and the popliteal angle is 45 degrees, and the scarf sign eval shows increased resistance to crossing the midline. The infant's skin is noted to be cracking with no veins visible. Creases over the entire sole of the plantar surface are noted. Based on findings what's the gestational age? correct answer 40 weeks For a term infant, the square window angle would be 0 degrees, the popliteal would be 90 degrees, and in scarf sign testing, the elbow could not be pulled over the infant's body A mother reports that her week old daughter "has her own breast milk" On exam, the infant has enlarged breast tissue and milky secretions, but the chest otherwise appears normal. Advice to mom is based off the knowledge that: correct answer This is normal and will stop on it's own- influence of maternal
estrogen can cause engorgement with "witch's milk." Will disappear after a few months A newborn infant born at 37 weeks is in the 5th percentile for weight, length, and HC. The most likely explanation for this finding is: correct answer Intrauterine infection- symmetric IUGR begins early in gestation and is most often caused by intrauterine infection or genetic abnormalities. Chronic fetal distress is implicated as a cause of asymmetric growth restriction, resulting in a larger HC in comparison to length and weight. Maternal HTN can cause asymmetric IUGR A newborn infant presents with cyanosis. On exam the nurse hears a murmur at the left upper sternal border, but hears nothing else unusual. What cardiac defect is most likely responsible for these findings? correct answer TOF- the most common cyanotic heart defect. A grade 2-4 murmur is heard over the left upper sternal border ASD- splitting of the second heart sound, no cyanosis VSD- murmur at the left lower sternal border A newborn is cyanotic, is grunting, and has a barrel chest and scaphoid abdomen, Upon auscultation the nurse hears bowel sounds in the L side of its chest. Breath sounds are diminished. Most likely cause? correct answer Congenital diaphragmatic hernia A newborn presents with FTT, liver failure, coppery brown skin rash, and purulent nasal discharge. The mother should be tested for? correct answer Syphilis A newborn's mother asks why the nurse is performing a gestational age assessment when she had ultrasonography to determine her due date. The best
secretions until approximately 2 weeks before the onset of delivery, term or preterm. A physical assessment performed on a newborn infant notes that the skin of the infant is wrinkling, the areolae are raised with 10-mm buds, and the pinna springs back from being folded. Based on these physical assessment findings, this infant is considered to be correct answer Term- beyond 38 weeks, subcutaneous tissue decreases which causes the skin to wrinkle, breast tissue nodule measures up to 10mm, cartilage in pinna *very postterm and extremely preterm are not gestational categories A systematic approach to the physical exam of a newborn should be performed: correct answer between 12-18 hours of life (after successfully transitioning-- at birth may be too soon) A term infant delivered vaginally had APGAR scores of 9 at 1 min and 9 at 5 mins. The maternal hx identifies that mom is hep B surface antigen +. The plan of care for this infant should include which one of the following options? correct answer Administer hep B immune globulin and hep B vaccine within 12 hours after birth. Term infant with negative mother should be given hep b vaxx at time of discharge A term infant if now 24 hours old and rooming in w/ mom. The infant was a c-sec due to maternal arrest of labor. Apgars of 7 and 8. Membranes ruptured 12 hours before delivery and were mec stained. Prenatal group B step screen at 36 weeks (-). Maternal T before delivery was 100.2. Assessment reveals color slightly pale, decreased peripheral pulses and perfusion in lower extremities, difficulty getting baby to latch, slight lethargy, and RR 80 w/ no grunting, flaring, or retractions. Interventions? correct answer Notify the pediatric provider and transfer infant to
the special care nursery for obs under a radiant warmer with the poss dx of coarction of the aorta -COA has the classic findings of decreased perfusion and pulses in the lower extremities. Can develop temp instabilities and poor feeding. VHD should be suspected when infants present with an increase in RR in the absence of any other resp distress and cyanosis A term infant is born to a mother with a history of cocaine use in pregnancy. The mother is concerned about the effects of cocaine on her baby. The nurse's response should be based on the knowledge that intrauterine cocaine exposure increases the risk of: correct answer perinatal infection and respiratory distress syndrome A term infant is born via normal spontaneous vaginal deliver. The infant is noted to be cyanotic when quiet but pinks up when crying. The most likely dx? correct answer Choanal atresia A term infant is noted to have low-set ears, a short neck with excessive skin, brushfield spots, a large tongue, and simian creases. This infant is at increased risk of correct answer Duodenal atresia Heart defects seen in Tri21 inckude cardial cushion defects, VSD, PDA, ASD, and TOF. Infants at increased risk of renal anomalies A term infant presents with tachypnea and increased WOB. The infant's O2 sat is 78%-80% despite being given 100% O2. Congenital heart disease is suspected. Which of the following defects is most likely to cause these symptoms? correct answer Transposition of the great vessels occurs when the aorta arises from the RV and the pulmonary artery rises from the LV. Marked cyanosis is a presenting feature because the aorta carries deoxygenated blood from the RV to the systemic circulation
Potentially, the entire neonatal blood volume can hemorrhage into this space. Crosses the suture lines. Nurse should monitor serial head circumferences ad HCT levels and observe for signs of shock After a vaginal delivery complicated by a prolonged second stage, a term infant is noted to have bruising over the occiput with a small firm mass on the right side of the sagittal suture. The mass does not cross the suture line. This is likely a: correct answer Cephalohematoma- collection of blood under the periosteum most likely found over the parietal or occipital bones After a vaginal delivery, a newborn infant is noted to have an enlarged fluctuant nontender scrotal sac. The left scrotum is larger than the right. There is no tenderness, but the scrotum appears bruised. The most likely explanation? correct answer hydrocele - can be transilluminated After resuscitation of a term infant delivered after a motor vehicle accident, the infant is noted to be pale with sats of 95%. The BP is 34/22 (28). Tone is diminished and blood glu is 30. First action at this time would be? correct answer Give a 30mL NS After the birth of an infant through pea soup meconium who has poor muscle tone and inadequate breathing, the appropriate first step is to: correct answer Place the infant on the radiant warmer, dry, stimulate, and clear the airway After the initial assessment of the newborn, the infant's weight, length, and HC are plotted out on a growth chart. The growth chart shows that the infant's weight is at the 15th percentile, length is at the 20th, and HC is at the 30th. These results indicate the infant is correct answer Appropriate for gestational age
After therapeutic cooling for HIE, the nurse notes a 1.5 cm area of induration on the infant's right arm and a second small, firm nodule over the sacrum. Which of the following should be monitored in this infant? correct answer Calcium- these nodules are the result of subcutaneous fat necrosis, a complication of cooling. In the presence of multiple nodules, the risk of hypercalcemia is increased; Mg, Na, & K are not affected by the presence of these nodules An appropriate gestational age for glucose screening in women who are at low risk for developing gestational diabetes is correct answer 24-28 weeks' gestation. Patients with risk factors (>35 years, body mass index >30, history of gestational diabetes, delivery of a LGA infant, polycystic ovarian syndrome, strong family hx) should receive a plasma glucose screening at their first prenatal visit followed by one at 24-28 weeks An extremely low-birth-weight infant born at less than 25 weeks can be scored using the New Ballard Score gestational age examination. Which of the following findings is expected in an infant born at less than 25 weeks? correct answer Plantar creases are absent- in the absence of foot creases, foot length (heel to toe) is the characteristic scored An infant born at 33 weeks gestation is now 2 weeks old and is noted to have an umbilical mass and persistent fluid drainage in the umbilical area. The infant is otherwise well and there is no erythema or edema around the umbilicus. The most likely explanation for this finding is? correct answer Umbilical granuloma- most common umbilical mass and most frequently identified after cord separation due to persistent drainage from the umbilicus An infant is admitted to the NICU for mgt of neonatal abstinence syndrome secondary to maternal methadone use. Assessment of this infant is based on the knowledge that symptoms of methadone withdrawal typically present at how many days of life? correct answer 2-3 days
Variable decelerations- amnioinfusion is used to attempt to resolve variable fetal heart rate decelerations by correcting umbilical cord compression as a result of oligohydramnios. Must be careful to not cause polyhydramnios An otherwise healthy infant is found to have eight cafe au lait spots scattered over his trunk and extremities. This infant should be investigated for the presence of what condition? correct answer Neurofibromatosis An SGA infant is born with hypoplasia of the arm with cicatricial scarring and microphthalmia. The most likely cause of these findings is congenital infection caused by? correct answer Varicella- cicatricial scarring is a classic finding in congenital varicella. Limb hypoplasia and microphthalmia are also described with this condition An SGA infant is born with several anomalies, including micrognathia, a cleft lip, overlapping digits, rocker bottom feet, and cutis aplasia. Most likely explanation? correct answer Trisomy 13 Aortic stenosis correct answer Usually asymptomatic at birth. When PDA closes, pallor, mottling, and poor perfusion mat develop As part of a developmental assessment, the nurse is assessing the infant's ability to fixate on a picture of a human face. The technique she uses is based on the knowledge that a term newborn can be expected to briefly fixate on objects at a distance of _____ in? correct answer 10- At 6 days of life a 24 week neonate is noted to have edema of the eyes with reddened conjunctiva and yellow discharge The most likely cause is: correct answer Chalmydia trachomatis infection- onset of symptoms is between 5-7 days
Herpes infection of the eye presents with keratoconjunctivitis, inflammation of the cornea, and conjunctiva, some edema may be present but no purulent discharge Bilious vomiting requires immediate evaluation for correct answer Midgut volvulus Cardiac arhythmias and cleft lip can be seen in infants exposed to which substance in utero? correct answer Amphetamines Chest compressions are most effective if: correct answer They are performed at a rate of at least 90/ min 90 compressions/min, 30 breaths/min, compress 1/3rd of the anteroposterior diameter. Performed after 30s of PPV with no results Cutaneous candida correct answer beefy red rash with satellite lesions. Found in the groin, diaper area, and occasionally in other skin folds such as the axilla Despite continuous PPV via ETT, a newborn is persistently cyanotic. The HR remains less than 100 bpm. Breath sounds can be heard over both the lung fields and the stomach. The stomach is distended. Most likely, the ETT is: correct answer In the esophagus During a routine assessment after a spontaneous vaginal birth at term gestation, the neonate is pink when crying but demonstrates central cyanosis when quiet. Breath sounds are equal w/ no tachypnea. Most likely cause? correct answer Bilateral choanal atresia *neonates are obligate nose breathers
Elevated maternal serum a-fetoprotein is associated with: correct answer neural tube defects- MSAFP is a protein made by the fetal liver. High levels may indicate neural tube defects or ventral abdominal wall defects, esophageal and duodenal atresia, and some renal or urinary tract anomalies. Low levels occur in some case of down syndrome Erythema toxicum correct answer A pustular rash on an erythematous base. Tends to fade in one location and reappear in another Exposure to mag sulfate before delivery increases the likelihood that the newborn will develop: correct answer hypotonia and resp depression (signs of hypermagnesia) also poor suck, weakness, lethargy. Depresses deep tendon reflexes General considerations for accurate use of gestational age assessment tool, such as the Dubowitz score or New Ballard Score, include which of the following? correct answer Perform the exam within 48 hours of life for the best accuracy Gestational age is defined as: correct answer The time between the last menstrual period and the day of delivery Head circumference indicates brain correct answer growth- normal 10th-90th% In assessing a 3 day old infant with a hx of chronic intrauterine narcotic exposure, the nurse would expect to find correct answer skin excoriation, diarrhea, tachypnea, hyperthermia, jitteriness, tremors, sleeplessness, hypertonia In the immediate newborn period, the nurse should assess the PMI by placing the stethoscope over which intercostal space? correct answer 5th- because of the
dominance of the RV, the PMI best heard over 5th in the immediate newborn period Pulmonic valve- second intercostal Mitral valve- third intercostal Apex- 4th intercostal Length measurement entails measuring the infant: correct answer crown to heel LGA is birth weight correct answer greater than the 90th percentile Low birth weight is classified as birth weight less than: correct answer 2500g very low birthweight <1500g extremely low birthweight <1000g Microphthalmia, cataracts, glaucoma, chorioretinitis, and congenital heart disease are characteristic of which infection? correct answer Congenital Rubella Milia correct answer small white cysts appearing most often over the nose and chin of the newborn Occurs in males, presents with long limbs, elbow dysplasia, clindodactyly of the 5th finger, hypospadias, hypogonadism, and cryptorchidism correct answer Klinefelter Syndrome SGA infants are at risk for which of the following: Anemia, Hyperthermia, Hypoglycemia, Brachial plexus palsy correct answer Hypoglycemia- SGA infants
The most effective intervention to treat respiratory distress in the infant with intestines herniated in the chest cavity is: correct answer Intubation and ET tube ventilation The mother of a healthy full teem newborn asks about the hymenal tag that she saw when changing her daughter's diaper. The nurse's response is based on the knowledge that: correct answer Tags are benign and resolve spontaneously- usually disappear within a few weeks of delivery The mother of a newborn born at 24 weeks is worried about her infants eyes being fused. Which statement indicates the nurse's understanding of fused eyes? correct answer Fused eyelids normally open between 26 and 28 weeks' gestation. The mother of an infant born at 28 weeks gestation tells the nurse that she is very worried because her baby's ears do not look normal. Which of the following is the best explanation to give her? correct answer As a baby matures, the pinnae of the ears will mature and the cartilage will eventually firm up -genitilia will mature, skin will thicken, and subcutaneous fat will beceome deposited The neonatal nurse is called over to the labor and delivery dep to assess a term infant in resp distress after an uneventful vaginal delivery. Upon arrival, the l&d nurse is providing bag mask ventilation. Infant appears dusky. Abdomen has scaphoid appearance Breath sounds are not audible on the L side of the chest, Heart sounds more prominent on the R side. Based on this info, infant most likely has? correct answer Diaphragmatic hernia The nurse caring for a 2 day old African American infant notices a scattered rash on the infant's face and trunk. The rash consists of a mix of vesicles, pustules, and brown macules. The infant is afebrile and feeding well. The rash most likely
represents: correct answer Transient neonatal pustular melanosis- pustular melanosis is more common in infants with pigmented skin. The benign rash consists of a mixture of vesicles and pustules and pigmented macules. The vesicles and pustules resolve quickly, however the macules may remain for several months. The nurse is performing a gestational age assessment on a premature infant. Observations will likely include which of the following? correct answer Preterm infants have smooth plantar surfaces, which develop creases as the mature, and large amounts of lanugo over the shoulders and back, which will eventually slough off into the amniotic fluid as they get closer to term. Vernix covers preterm fetuses, but sloughs off into the amniotic fluid as the fetus develops, so that by term it is only left in the skin folds like the groin and axilla. The presence of central cyanosis is assessed in which part of the body? correct answer Tongue The recommendation for when to use neonatal assessment tools for gestational age assessment is: correct answer birth to 5 days before physical characteristics change The strength of the lower extremities can be evaluated by eliciting which reflex? correct answer Stepping The use of epi in neonatal resuscitation for bradycardia less than 60 bpm is recommended when? correct answer Following initial steps, 30 seconds of effective ventilations, and 60 seconds of chest compressions
