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This comprehensive study guide provides a series of questions and verified answers for the neonatal resuscitation program (nrp) final exam. it covers key aspects of neonatal resuscitation, including initial steps, positive-pressure ventilation, intubation techniques, and the management of various complications. The guide is designed to help students prepare for the exam and improve their understanding of neonatal care.
Typology: Exams
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1. 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? Insert a laryngeal mask
has a heart rate of 60 beats per minute. What is the most important action you can take? Provide positive pressure ventilation
used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)? 2.5mm
baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Start positive pressure ventilation and check HR response after 15 sec.
apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? 100 bpm
has meconium-stained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be Present at birth
stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? The baby should be brought to the radiant warmer for initial steps ofnewborn care
spontaneous breathing in a baby that is apneic after initial steps? Administration of positive pressure ventilation that inflates the lungs
birth, does not respond to initial steps and requires positive- pressure ventilation. What concentration of oxygen should be used as you begin positive-pressure ventilation? 21-30%
newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation? A rising HR
she is not breathing (apneic), but she soon establishes spontaneous respirations and a heart rate over 100 beats per
Is the baby breathing or crying?
requires supplemental oxygen in the delivery room? Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation.
birth. What are the initial steps of newborn care? Provide warmth, position head and neck to open the airway, clearsecretions from the airway if needed, dry, stimulate
within which duration? 30 seconds
best performance. Which of these characteristics is critical in team leaders? They should be able to maintain situational awareness
healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help? Before birth, when you have identified thepresence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.
What is the most important and effective action to take in the resuscitation of this baby?
Provide positive pressure ventilation
using a pulse oximeter in the delivery room? Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation.
intubation? The need for positive pressure ventilation lasting more than a few minutes
Program® training and trying to decide who should be included. For every delivery, what is the minimum requirement for care of the newborn at birth? Someone capable of initiating neonatal resuscitation should bepresent at every delivery whose only responsibility is management of the newborn.
ongoing respiratory support and chest compressions. You and 3 colleagues provide care immediately following birth. What behavioral skills are critical to ensure successful and optimal care during resuscitation? Teamwork, leadership, communication
per minute despite 30 seconds of positive-pressure ventilation that moves the chest. Your team plans to intubate. Which of the following is a true statement regarding the procedure? The baby should be positioned on a flat surface with the
pain relief 1 hour before delivery. The baby does not have spontaneous respirations and does not improve with stimulation. Your first priority is to Start positive pressure ventilation
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 trans- illumination, also reveals a bright glow on the left side. What is the most likely cause of this distress? Left side pneumothorax
and resources needed for a very preterm birth? Prepare thepreheated radiant warmer with a thermal mattress, plasticwrap or bag, and a hat.
cord clamping in vigorous preterm newborns? Decreased need for blood transfusions
(0.1 mg/mL) concentration of intravenous epinephrine is indicated? 0.1ml
After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute.
What is your next action? Stop chest compression-continuepositive pressure ventilation
epinephrine should you pause compressions and reassess the baby's heart rate? 1 minute
during chest compressions? ECG monitoring
and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? ET tube is in too deep
should the room be set? 23ºC to 25ºC (74° F - 77 ° F)
are started, the heart rate should be assessed: after 60 seconds
surrogate decision maker(s) for a newborn? The newbornsparents
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
be checked soon after resuscitation and then at regularintervals until stable and normal.
concentration of epinephrine for endotracheal administration to a baby weighing 3 kg? 1.5 ml
chest compressions, how many events are performed each minute? 30 breaths, 90 compressions
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? Respiration, heart rate, oxygen saturation
resuscitating and stabilizing extremely premature newborns? They have more difficulty achieving effective spontaneous ventilation than term newborns
volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.
gestational because of sudden fetal bradycardia and a
suspected placental abruption. After birth, the baby required extensive resuscitation including positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, the baby has poor tone, lethargy, and apnea. Which of the following statements is true? Promptly evaluate her for possible therapeutic hypothermia (cooling)treatment and contact the nearest cooling center.
is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation? The option of providing comfort care can be considered.
Which action is appropriate with a pulse oximeter and blender during and immediately following resuscitation of preterm babies? Adjusting the oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 10 minutes after birth.
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? Respirations, heart rate, oxygen saturation
preterm newborn? 36.5ºC to 37.5ºC (97.7-99.5)
- Start PPV if baby is not breathing (apnea) OR if the
- Start PPV if the baby appears to be breathing, but
- Call for help if alone at the warmers - If the baby has not responded to the initial steps