NCC Exam Practice Questions with Answers, Exams of Nursing

Download NCC Exam Practice Questions with Answers and more Exams Nursing in PDF only on Docsity! NCC Exam Practice Questions with answers Which of the following is a gram negative rod? ✔E. Coli Which if the following could have a tentative identification of "cocci in chains"? ✔Streptococcus Which antibiotic best treats Chlamydia? ✔Erythromycin Dark blue or magenta colored papules or nodules (blue berry muffin sign) sometimes seen with congenital CMV are a result of what? ✔Extramedullary dermal erythropoiesis Fetal hemoglobin shifts the oxy-hemoglobin dissociated curve to the? ✔Left Alkalosis shifts the oxy-hemoglobin dissociation curve to the? ✔Left Which of the following is NOT a problem that can occur with chronic lasix therapy? ✔Metabolic acidosis When performing a needle aspiration for a pneumothorax, the needle should be places where? ✔Above the rib Which of the following is NOT a reason to use flucytosine in conjunction with amphotericin B? ✔The incidence of adverse effects is decreased A 33 week gestation infant displays the following characteristics at one minute of age: HR 90 No respiratory effort Some flexion of extremities Weak reflex irritability Blue and pale ✔3 A 900 gram infant is receiving NS flushes of 1mL every 4 hours. How many meq/kg/day of Na+ is the infant receiving from flushes? ✔1 meq/kg/day An IV of D12W is running at 6mL/hr. How many mg/kg/minute of glucose if a 1500 gram infant receving? ✔8 mg/kg/minutes When doing an LP, what is the most appropriate interspace? ✔L4-5 Low umbilical artery catheters should be places where? ✔L3-4 Soft tissue on an overpenetrated CXR will look? ✔dark In utero blood going through the patent ductus arteriosus travels which direction? ✔right to left A 27 week gestation infant presents with bounding pulses, tachypnea, increased O2 requirement, and a Grade II holosystolic murmur on day 2 of life. Blood shunting through the PDA is most likely being shunted which direction? ✔left to right A full term infant presents with cyanosis that does not respond to O2 in the delivery room and a single S2 is also noted. Which of the following defects does the infant most likely have? ✔Pulmonary atresia S1 is best heard where? ✔apex The CXR of an infant with hypoplastic left heart syndrome will most likely have? ✔increased pulmonary vascular markings ✔Low T4 & elevated TSH Diabetes insipidus is most often associated with what? ✔Increased plasma osmolality What will be increased in rickets of prematurity? ✔Alkaline phosphatase levels Scalded skin syndrome is seen with: ✔Staphylococcus aureus infection The Ladd procedure is done for infants with what? ✔Malrotation Two homozygous parents will pass on a trait to what % of their offspring? ✔100% of the offspring ROP in which of the following Zones is most severe? ✔Zone 1 Which of the following is the best definition on Plus Disease in ROP? ✔A significant level of vascular dilatation & tortuosity observed at the posterior retinal vessels Treponema pallidum is most frequently transferred how? ✔transplacentally The drug of choice for an infant with congenital syphilis is what? ✔aqueous crystalline penicillin G Which of the following infants should definitely be treated for congenital syphilis? ✔a reactive result on VDRL of CSF The most common route of HIV transmission postnatally is ✔Breastfeeding The best method for diagnosing HIV postnatally is? ✔HIV DNA PCR Where is the apical impulse on the first few hours of life? ✔5th intercostals space at the lower left sternal border Which of the following cells are responsible for the production and secretion of surfactant? ✔Type II pneumocytes Which of the following surfactant proteins functions as the major innate host defense protein? ✔SP-A Which of the following newborn infants should receive Varicella-Zoster Immune Globulin? ✔Mother with varicella 5 days or less prior to delivery Giving Vitamin D to a premature infant with osteopenia assists how? ✔Increases Calcium absorption by intestines & kidneys Aminoglycoside elimination in newborns occurs primarily how? ✔unaltered by glomerular filtration A baby presents with thrombocytopenia related to maternal isoimmune thrombocytopenia. Which of the following is true about the thrombocytopenia found in these infants? ✔the treatment of choice is washed irradiated maternal platelets The best antibiotic treatment for an infant with with a Klebsiella infection would be what? ✔an aminoglycoside The best antibiotic to treat a staphylococcus aureus infection would be what? ✔oxacillin The initiation of protein digestion in the neonate is dependent on what? ✔enteropeptidase Aspiration of the vesicles in pustular melanosis will yield what? ✔numerous neutrophils The anterior vascular capsule of the lens will usually be gone by what gestation? ✔34 weeks Where does a cephlahematoma occur? ✔between the periosteum and skull bone Most cerebral myelinization occurs when? ✔after birth Which of the following IV fluids will deliver 8 mg/kg/minutes of glucose at 80 mL/kg/day? ✔D15W A biophysical profile score of 6 is considered what? ✔equivocal How does carbon monoxide (CO) relate to bilirubin production? ✔CO binds tightly to hemoglobin & forms carboxyhemoglobin. It is liberated by the mass effect of O2 & expelled in expired breath. The tetrad of clinical signs of kernicterus are? ✔abnormal motor control oculomotor impairments sensorineural deafness dental enamel dysplasia In the presence of hyperammonia, which of the following signifies urea cycle defect? ✔elevated citrulline An infant presents with oomphalocele, macroglossia & hypoglycemia. The most likely diagnosis for the infant is? ✔Beckwith-Wiedemann Syndrome To perform a Bruckner test, the ophthalmoscope should be how many inches away from the infant's face? ✔18-20 inches The bell of the stethoscope is best at detecting sounds that are: ✔40 bpm Seesaw respirations in newborns are suggestive of: ✔loss of lung volume In extremely premature infants, periodic breathing may persist until how many weeks gestational age? ✔44 weeks A barrel-shaped chest is a finding commonly seen infants with: ✔transient tachypnea Maternal lithium use is associated with which of the following heart defects? ✔Ebstein malformation Which of the following extra-cardiac anomalies is associated with an increased risk of congenital heart disease? ✔diaphragmatic hernia In newborns with a normal hemoglobin level, central cyanosis is not usually visible until the arterial saturation falls below: ✔80-85% Lesions that result in bounding pulses incluse: ✔PDA In the immediate newborn period, the point of maximal intensity (PMI) is usually best felt in which intercostal space? ✔5th In neonates, abdominal circumference is less than head circumference until how many weeks gestation? ✔30-32 weeks A flaccid, lumpy, abdominal wall is characteristic of: ✔Eagle-Barrett Syndrome Bilious emesis is associated with a gastrointestinal obstruction below the level of the: ✔ampulla of Vater An umbilical hernia is a feature of: ✔hypothyroidism Anomalies associated with gastroschisis include: ✔bowel atresia Neonates with a history of oligohydramnios should be observed for: ✔pulmonary hypoplasia The descent of the testes from the abdomen into the scrotum begins at approximately how many weeks gestation? ✔28-30 weeks In term, female infants the effects of maternal estrogen can persist for up to how many weeks? ✔8 weeks Renal anomalies associated with Eagle-Barrett syndrome include: ✔hydronephrosis In cases of testicular torsion, the gonad is usually unsalvageable when ischemia exceeds how many hours? ✔4-6 hours the average daily weight gain for a term newborn is how many g/kg/day? ✔10-20 g/kg/day The average head circumference of a term newborn at birth is how many cm? ✔33-35 Macrodactyly is a finding in which of the following? ✔lipoma Puffy hands and feet are a characteristic finding of what dyndrome? ✔Noonan Infants with radial hypoplasia should be investigated for: ✔VACTERL association Phasic tone is evaluated by testing the: ✔deep tendon reflexes The strength of the lower extremities can be evaluated by eliciting which reflex? ✔stepping Pupillary response to light is normally present by how many weeks gestation? ✔28-30 In infants with severe encephalopathy; apnea, weakness and jitteriness are seen in which period after brith? ✔12-24 hours Neurologic signs of in utero exposure to cocaine include: ✔poorly organized responses How many states are identified on the Anderson Behavioral State Scale? ✔12 In newborns, avoidance behaviors include: ✔yawning Habituation is best assessed in what state? ✔drowsy alert The optimal distance for a newborn to focus on an object is how many inches? ✔10-12 inches In describing temperament, the individual's response to a new situation once the initial response has passed is termed: ✔adaptability What % of newborn deaths are attributed to a birth defect? ✔20% Which of the following birth defects is known to be inheritable? ✔Transposition of the Great Vessels How would TET present on ECHO? ✔large VSD pulmonary stenosis or right outflow tract obstruction overriding aorta right ventricular hypertrophy When is cyanosis visible on exam? ✔when there is a 5 gram reduction in hemoglobin What site can you obtain a pre-ductal arterial blood gas? ✔right radial artery What arteries can be used to assess shunting? ✔Right radial artery Umbilical artery An infant with ambiguous genitalia most likely has what? ✔Congenital adrenal hyperplasia Congenital adrenal hyperplasia is a disorder of what? ✔21-hydroxylase deficiency With PPHN, the PDA blood flows in which direction? ✔Right to Left How do you determine insertion depth of an ETT? ✔NTL + 1 weight in kg + 6 Signs and symptoms of hypothyroidism appear around what age? ✔6 weeks What is the drug of choice for hypothyroidism? ✔L-thyroxine (Synthroid) Infant has PPHN, had a UAC for 7 days; develops HTN and hematuria. What is the most likely cause? ✔renal artery thrombosis How does renal vein thrombosis prespent? ✔flank mass (kidney swollen from impaired venous return) hematuria elevated creatinine How does Coarctation of the Aorta present? ✔SpO2 difference of 10% in upper and lower extremities What presents as thumb and radial x-ray abnormality, café-au-lait spots, and occurs in Jewish decent? ✔Fanconi anemia Inherited clotting disorder that is deficient in factor VII and IX: ✔hemophilia What presents with craniofacial malformation, thumb and upper limb abnormality, cardiac abnormality, LBW, cleft palate, and general growth delay? ✔Diamond-Blackfan anemia Oliguria is defined as: ✔UOP <1ml/kg/hr Polyuria is defined as: ✔UOP >4-5ml/kg/hr Potter's sequence is characterized as: ✔(oligohydramnios) pulmonary hypoplasia limb deformities flat facies with beaked nose What are some causes of oligohydramnios? ✔BIL renal agenesis Posterior urethral valves Bilious emesis, abdominal distention, no stooling, and polyhydramnios are all indicative of what? ✔Intestinal tract obstruction Gancyclovir treats what? ✔Hearing loss associated with CMV Barium enema is diagnostic for what? ✔Hirschsprungs How to differentiate between maternal and fetal blood in and infant with hematemesis or hematochezia: ✔Apt-Downey Test A term infant presents with an abdominal mass, is tolerating feedings, voiding/stooling and otherwise well appearing. What do you suspect? ✔Neuroblastoma What is the most common neonatal tumor? ✔Neuroblastoma What size ETT would you use for a 32 week infant weighing 1.1 kg? ✔3.0 ETT Interpret the ABG: 7.11 / 68 / 175 / -10 ✔Mixed acidosis caused by a pulmonary problem What medication is most likely used for NAS? ✔Methadone Polyhydramnios is associated with what? ✔Anencephaly Infant is born LGA with shoulder dystocia, what do you asses for? ✔Brachial plexus injury (Most common being Erb's Palsy) An upper air way infections that presents with mucopurulent eye drainage is most likely caused by what? ✔virus What lab finding would be associated with perinatal asphyxia? A neonate is born with petechiae, hepatosplenomegaly, microcephaly and chorioretinitis. A subsequent ultrasound demonstrates intracranial calcifications. It should be suspected that this neonate was exposed to ✔cytomegalovirus (CMV) An expected umbilical cord laboratory value in an Intrauterine growth restricted fetus is increased ✔lactate A neonate who has a history of necrotizing enterocolitis and required an ileostomy is now ready for surgical re-anastomosis prior to discharge. Which of the following procedures should be completed prior to re-anastomosis? ✔Lower GI study Stimulation of the sympathetic nervous system by cold exposure in neonates ✔increases local norepinephrine turnover within brown adipose tissue Research-based evidence regarding use of humidity in an incubator includes ✔improved energy balance The ideal rate of weight gain for extremely low birthweight neonates is ✔20 g/kg/day The most commonly encountered long-term problem in survivors of congenital diaphragmatic hernia is ✔gastroesophageal reflux Continuous positive airway pressure is an effective treatment option to prevent ✔alveolar collapse C- reactive protein testing is best used for ✔serial monitoring of response to antibiotic treatment Destroying the acid mantle of the skin in the neonate results in ✔an increase in microbial colonization and a shift in species Elimination of fetal lung fluid is caused by ✔activation of sodium selective epithelial channels The radiographic findings consistent with transient tachypnea of the newborn include ✔vascular congestion and increased perihilar markings In a neonate undergoing repair of a right unilateral inguinal hernia with the finding of undescended testes, what other surgical procedure should be performed? ✔Orchiopexy An effective therapeutic intervention to reduce the incidence and severity of retinopathy of prematurity is ✔promotion of good post-natal growth The most frequent site of neurologic injury that results in cerebral palsy in the neonate is ✔white matter damage The most frequent complication of grade 3 and 4 intraventricular hemorrhage in the neonate is ✔post hemorrhagic hydrocephalus The best predictive laboratory value for bilirubin neurotoxicity in the neonate is ✔unbound bilirubin A newborn screen result for a preterm neonate demonstrates a high TSH and a low free T4. These results indicate ✔primary hypothyroidism A term neonate is born by vaginal delivery. After birth, a firm swelling that crosses cranial suture lines and is fluctuant to palpation is noted. What is the most likely diagnosis? ✔Subgaleal hemorrhage A neonate with a patent ductus arteriosus often presents with ✔wide pulse pressures A neonate is found to have anal atresia, ventricular septal defect, tracheoesophageal fistula and vertebral anomalies. Which other congenital anomaly is the neonate most likely to have? ✔Renal dysplasia The highest level of evidence on which to base nursing practice is ✔systemic reviews or meta-analysis Simulation exercises and debriefing periods for enhancing patient safety are used to ✔improve team work A maternal antibiotic that is passed into breast milk in equal concentrations to maternal serum values is ✔sulfonamides Abnormal CSF findings in meningitis ✔WBC >30 glucose >50% of serum Protein >100 Positive culture/gram stain Pending sensitivity results, the appropriate antibiotic for an unidentified gram negative meningitis is ✔cefotaxime Organism coverage of Cefotaxime ✔Broader gram negative (-) coverage Crosses BBB Organism coverage of Cefepime ✔Broader gram positive (+) AND gram negative (-) coverage Treats Pseudomonas When using gentamicin, effective treatment is dependent on ✔maximal concentration of the drug What are the optimal and toxic TROUGH gentamicin levels? ✔Optimal: 0.5-2 Toxic: >2 What are the optimal and toxic PEAK gentamicin levels? ✔Optimal: 5-10 Toxic: >12 A potential irreversible adverse side effect of aminoglycoside exposure is ✔Posterior urethral valves A 3 day old neonate has hematuria, decreased urine output and a platelet count of 60,000. Which of the following is the most likely diagnosis? ✔Renal vein thrombosis A preterm neonate has a prolonged resuscitation at birth. The infant is still experiencing respiratory distress and an arterial blood gas reveals the following: 7.30 / 60 / 60 / 24 / -2 When interpreting this arterial blood gas, it should be recognized that: ✔the primary problem is respiratory When both proximal and distal weakness occur, it is termed ✔Total Plexus Palsy A 32 week gestation infant with decreased renal function develops systematic candidiasis. The best choice of anti-fungal therapy for this baby is ✔amphotericin B lipid complex A 12 hour old male infant appears hypotonic with generalized muscle weakness and absent deep tendon refluxes. There is no family history of neuromuscular diseases. Which of the following would be the first step in diagnostic evaluation? ✔Creatine Phosphokinase (CPK) level A 2 day old male is persistently bleeding 12 hours post circumcision. The cause of this bleeding is most likely ✔factor VIII deficiency A 780 gm infant has a bilirubin level of 17 at 24 hours age. The treatment of choice is ✔exchange transfusion and phototherapy An 8 hour old neonate is irritable and tremulous. These findings are consistent with withdrawal from in utero exposure to ✔heroin The x-ray of a neonate with suspected NEC shows pneumoperitoneum. This finding is consistent with ✔bowel perforation Infants born to mothers with myasthenia gravis ✔are at risk for respiratory failure A factor that usually differentiates the pathophysiology between meconium ileus and meconium plug syndrome is ✔enzymatic deficiency A neonate has had several episodes of vomiting. The arterial blood gas results are 7.53 / 42 / 56 / 33 This blood gas respresents: ✔metabolic acidosis A late preterm infant presents with recurrent oral thrush. The most likely source would be ✔breast A neonate with coarctation of the aorta develops intractable congestive heart failure, acidosis, oliguria, and HTN. the appropriate action is immediate ✔cardiac catheterization A common complication of percutaneous central lines include ✔extravasation A risk factor for bronze baby syndrome is ✔cholestasis The mandatory diagnostic test for infants suspected of having congenital syphilis is ✔CSF VDRL An increase in cerebral blood flow can be expected in associated with ✔decreased PaO2 Infants with Beckwith-Wiedmann Syndrome are at risk for? ✔Wilms tumor A characteristic that is present in both oomphalocele and gastroschisis is ✔non-rotation of the intestine On gestational age examination, a neonate falls below the expected range for weight, length and head. A likely antecedent for this growth aberration is ✔intrauterine congenital infection Brain reperfusion injury occurs after oxygenation of perfusion has been restored for ✔8-16 hours An increase incidence of low serum calcium levels occurs in neonates who ✔have a history of asphyxia Glucose use by the brain is greater in infants who are ✔asymmetrically growth restricted Which milk protein is easiest to digest? ✔Whey Cystic fibrosis is characterized by ✔meconium ileus Increased left atrial pressure is responsible for what circulatory change at birth? ✔Elimination of right-to-left shunting at the foramen ovale What size ETT should be used to resuscitate a 36 week 2500 gm infant? ✔3.5 mm The correct position for cardiac compressions during neonatal resuscitation is where? ✔just above the xiphoid process The recommendation regarding the administration of naloxone to the newborn with respiratory distress secondary to maternal administration of narcotics is to ✔avoid administration What element of pharmacokinetics is most important to consider when prescribing a drug that has a narrow therapeutic range? ✔Bioavailability A term, healthy infant, who has been breastfeeding well develops jaundice on day 5 of life. The bilirubin peaks on day 14 of life. This type of jaundice is called ✔breast milk jaundice ✔the severity of parenchymal lung disease Energy intake for growth and parenteral nutrition are ✔90-100 kcal/kg/day The optimal time to perform a gestational age assessment for the neonate born at 26 weeks gestation is ✔within 12 hours of age Diagnosis of hypertelorism or hypotelorism is primarily based on the measurement between ✔the epicanthal folds Osteopenia of prematurity in the very low birth weight neonate is most commonly caused by ✔insufficient intake of calcium and phosphorus Initial broad-spectrum treatment of suspected or confirmed bacterial EOS should include an aminoglycoside such as gentamicin and what other antibiotic for synergy? ✔ampicillin What broad spectrum antibiotic is used to treat gram positive (+) cocci? ✔Vancomycin Which antibiotics provide anaerobic coverage in treatment of NEC or SIP? ✔Clindamycin Flagyl Zosyn Physiologic characteristics of Ebstein's Anomaly include ✔downward displacement of the tricuspid valve Calculation of the maintenance dose of a drug depends primarily on ✔half-life PPV with 21% oxygen is administered at delivery, and the HR after 30 seconds is 102 and increasing. The next intervention is to ✔observe for spontaneous respirations, then discontinue PPV Vitamin K facilitates the coagulation process by ✔converting inactive precursors into active clotting factors Amnioinfusion during labor may minimize the morbidity caused by ✔cord compression A clinical sign that appears in the neonate with congenital heart disease that reflects development of pulmonary edema is ✔tachypnea The organism most commonly responsible for EOS bacterial infection in the neonate is ✔GBS The infant of a diabetic mother presents with signs of low intestinal obstruction. Following contrast studies, the infant promptly evacuates the barium and begins passing stool. The most likely diagnosis is ✔small left colon Which immunologic component is important in graft-vs-host disease? ✔T-Lymphocytes A major advantage of ultrasound over other diagnostic imagine methods is ✔there is no radiation exposure VSD should be suspected in the neonate if ✔a pronounced murmur is heard Unresolved grief in the parent of a child with a disability that constantly reminds them of the loss of a healthy child is called ✔chronic grief Neonatal hypocalcemia is most likely to occur with ✔placental insufficiency Brushfield's spots are associated with ✔Trisomy 21 Hyperkalemia in a 2 hour old VLBW neonate with normal UOP is likely due to ✔A shift of K from the intracellular to ehe extracellular compartment Compared to indomethacin, ibuprofen reduces the incidence of side effects in which system? ✔Renal The most important site of medication biotransformation is ✔Liver The most common cause of neonatal hyperthyroidism is ✔Graves Disease Determine the Apgar score of following neonate: One minute: Pale; 40 bpm; No response; Limp; Weak and irregular Five minutes: Pink with blue extremities; 90 bpm; Grimace; Limp; Weak and irregular ✔2 at one minute 4 at 5 minutes Gentamicin resistant organisms are present in a nursery. The appropriate treatment of the neonate with EOS would be ampicillin and ✔cefotaxime Recommended treatment of CSF gram strain positive for gram negative bacilli is ✔ampicillin and cefotaxime Continued posturing of a limb is characteristic of ✔tonic seizures A neonate is oliguric. a 10-20 ml/kg body weight test dose is given IV over 1 hour. If the problem is pre-renal, then the UOP should ✔increase Patients with respiratory distress syndrome demonstrate a characteristic grunt during expiration. This is an attempt to ✔maintain FRC The neonate in the early stage of CHF may increase their HR to compensate for ✔decreased CO Infants of diabetic mothers are at increased risk for hypoglycemia because of insulin- stimulated peripheral glucose uptake and ✔inhibition of gluconeogenesis The rise in glomerular filtration rate after birth can be attributed to ✔expansion of the filtration surface area During resuscitation an infant is noted to have weak peripheral pulses, persistent tachycardia and diminished muscle tone. The most appropriate intervention would be ✔normal saline 10mL/kg A statement that characterizes neonatal renal function in the VLBW neonate, is that the neonate has an ✔inability of the proximal tubule to reabsorb adequate amounts of sodium High-pitched sound heard on expiration ✔wheeze Maturation of the 25 week gestation neonate's skin may take up to how many weeks? ✔8 weeks In premature infants bilirubin levels generally peak on day ✔5 of life A neonate born to a mother who developed varicella rash 3 days prior to delivery should receive ✔VariZIG Genital ambiguity should prompt the healthcare team to screen for ✔CAH A shunt study is preformed on a neonate with respiratory distress, and the PaO2 does not change with administration of 100% oxygen. It can be assumed that ✔right to left shunting is present A neonate is born by emergent c-section because of fetal maternal hemorrhage. Routine resuscitation was performed. He is now displaying signs of shock. The appropriate intervention would be to administer ✔volume expanders A preterm neonate who required resuscitation at birth is admitted to the NICU. Care for this infant would include ✔maintain head in midline position Which of the following is a characteristic of an autosomal recessive disorder? ✔parents are phenotypically normal Most medical and nursing errors occur because of ✔system failures When resuscitating a neonate with suspected diaphragmatic hernia, the most appropriate intervention is ✔insertion fo an ETT should be done ASAP The neurologic consequence of a hemorrhage within the germinal matrix and the ventricular system is ✔damage to periventricular white matter Bullous lesions appear on an infants skin on day 2 of life. This finding is ✔indicative of infection When giving medical information to parents of a premature infant, information should be presented ✔directly and honestly but using an individualized balanced approach When levels of PEEP are increased, they can worsen acute lung injury due to ✔barotrauma While caring for an infant born at 38 weeks gestational age who was admitted to the NICU to rule out sepsis, the NNP should understand which of the following related to physiology of thermoregulation? ✔Non-shivering thermogenesis is dependent on availability of glucose A 32 week gestational age male neonate has a 4 cm nontender mass in the right testicle. Differential diagnosis can be faciliated by ✔transillumination A two day old neonate has had no passage of stool since birth. Rectal examination accomplishes evacuation. The neonate shortly thereafter develops abdominal distension. The most appropriate diagnostic test to obtain is ✔rectal biopsy A five day old 1000 gm preterm neonate is suspected to be hypokalemic. Expected ECG findings are ✔depressed ST segment, flattened T wave A 5 day old infant develops a watery eye discharge that progresses rapidly to purulent exudate. Chlamydia trachomatis conjunctivitis is diagnosed. The NNP should be aware that ✔therapy of choice if oral erythromycin for 14 days Infants who "refer" on second hearing screen should have a full scale auditory diagnostic evaluation at ✔3 months of age A major characteristic of autosomal recessive disorders is ✔possible coconsanguinity Most safety initiatives are successful when the safety goals are based on ✔a change in the culture of the institution A cranial suture line of a neonate reveals an immovable bony prominence which is even and smooth bilaterally. This neonate should be evaluated for ✔increased intracranial pressure Of the following, the most common environmental trigger for patent ductus arteriosis is ✔amphetamines A neonate is 48 hours post-surgery 2° necrotizing enterocolitis and is on a ventilator. The neonate is grimacing and eyes are tightly shut. The heart rate is increased and the neonate is breathing over the ventilator. The most appropriate intervention would be to obtain an order for ✔pain medication Absence of the ileocecal valve in the neonate with short bowel syndrome can lead to ✔nutritional deficiencies and cholestasis Infection is suspected. The organism most likely responsible for this neonate's symptoms is ✔Listeria monocytogenes Risk management teams ✔reduce the hospital's financial liability Soy-based formulas are recommended for infants who have ✔galactosemia A neonate has a flat pink lesion on the nose. The lesion has diffuse borders, blanch with pressure and become pinker with crying. The nurse practitioner should suspect ✔nevus simplex Increased bowel sounds are indicative of ✔malrotation A neonate born at 36 weeks gestation weighing 3000g is at increased risk for ✔jaundice A woman on methadone wants to breastfeed. She should be advised that ✔supervised methadone use is compatible with breastfeeding Which of the following is most consistently associated with newborn acidosis and morbidity? ✔Absent variability with late or variable decelerations Concerning administration of immunizations to hospitalized preterm infants, the nurse practitioner should be aware that ✔measles-mumps-rubella vaccine should not be given Which milk protein is most difficult to digest? ✔casein In considering the embryology of the fetal lung, it would be assumed that at 20 weeks gestation ✔gas-exchanging acinar units are forming Which condition in term and near term infants should have a trial of inhaled nitric oxide? ✔hypoxic respiratory failure A characteristic that differentiates gastroschisis from omphalocele is ✔edematous and herniated bowel The absence of which reflex distinguishes total brachial plexus palsy from Erb's palsy? ✔Grasp The diffuse opacification seen on the chest x-ray of a neonate with respiratory distress syndrome primarily reflects ✔alveolar atelectasis To decrease the chance that a peripherally inserted central catheter (PICC) will advance into the jugular vein, the inserter should ✔turn the head toward the insertion site The cardiovascular system's response to epinephrine is determined by: ✔receptor availability The determination that the standard of care has been met is based on what similarity of a prudent and reasonable nurse? ✔Actions taken in the same situation The etiology of bronchopulmonary dysplasia (BPD) is multi-factorial. The contributing factor most closely associated with surfactant inactivation is ✔acute lung injury A neonate is receiving hydrochlorothiazide with spironolactone (Aldactazide) PO 1 mg/kg every 12 hours. The nurse should understand that the pharmacologic action ✔inhibits sodium reabsorption in the distal nephron The diagnostic tool that is most useful in establishing a cardiac cause for respiratory symptoms is ✔shunt study The method of surfactant administration that improves homogenous distribution of surfactant in lungs is ✔bolus administration The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to ✔limited subcutaneous tissue and brown fat stores The acid base derangement of respiratory alkalosis represents the presence of ✔increased alveolar ventilation The management of a newborn infant born to a mother with a positive tuberculin skin test, but who has no evidence of infection should include ✔no pharmacological intervention A giant nevus is the most concerning of the congenital pigmented nevi because ✔of increased risk of malignant transformation A term neonate status post abdominal surgery two weeks ago has the following arterial blood gas result. The neonate is on total parenteral nutrition.pH: 7.51PCO2 44 mm Hg PO2 61 mm Hg HCO3: 36 mEq/L When interpreting this blood gas, it should be recognized that ✔the primary problem is metabolic Limiting factors when deciding whether a LBW infant should be immunized per the CDC immunization schedule include ✔clinical condition Maternal fever during labor may increase the risk of ✔CP Effects of somatostatin include ✔inhibits pancreatic insulin release Which of the following metabolic imbalances may potentiate cardiac toxicity secondary to hyperkalemia? ✔Hypocalcemia The greatest risk to the fetus due to intrauterine infection with varicella occurs when the exposure to the infection occurs ✔gentle range-of-motion exercises Bullous lesions that appear after the second day of life usually suggest skin infection with ✔Staph Aureus The most prominent and sensitive skin thermal receptors are in the ✔trigeminal area of the face Common behavioral manifestations of neonates who were exposed to cocaine in utero include ✔difficulty alternating between alert and drowsy states A common cause of neonatal renal vein thrombosis is ✔birth asphyxia A term neonate is found to have ambiguous genitalia. The anticipated immediate action would include obtaining ✔blood electrolytes Most research studies regarding the use of soaps, lubricants and antimicrobial skin solutions in premature infants conclude ✔use of emollient creams may be of benefit The majority of hypertension in infants can be accounted for as a result of ✔intrinsic renal disease Neonatal manifestation of systemic lupus erythematosus is attributed to ✔placental transfer of antibodies to the fetus When caring for an infant on total parenteral nutrition, the nurse practitioner should recognize that ✔caloric intakes for parenteral nutrition are about 20% less than those for enteral nutrition Parental anticipatory grief is associated with ✔positive feelings about the pregnancy Which sense becomes the neurodevelopmental interface between the infant and the world at birth? ✔tactile A neonate was born to a mother who acquired varicella 4 days prior to delivery. The neonate should ✔receive varicella zoster immune globulin The nurse practitioner can facilitate parental adaption to their new role by ✔being a good listener When developing a plan for a preterm neonate to transition to oral feedings, the nurse practitioner should consider that ✔coordination of suck-swallow reflex and breathing is developed at approximately 34 weeks postconceptual age On examination of the anterior vascular capsule of the lens of a neonate, an expected change that would be noted as gestational age increases is ✔decreased cloudiness Decreasing the amplitude on high frequency oscillators results in ✔increased PCO₂ When considering the administration of central nervous system medications for neonates, the nurse practitioner should consider that the medication ✔must be lipid soluble Congenital cystic anomalies of the lung are associated with ✔fetal hydrops During a physical examination of a 36 week gestational age neonate, the grasp reflex is good, but the suck reflex is weak and not synchronized with swallowing. The nurse practitioner should recognize that this is most likely due to ✔prematurity A partner's reaction to stress is ✔just as important as the mother's reaction On examination of the eyes, a neonate demonstrates symptoms of infantile glaucoma, such as tearing, squinting, photosensitivity, and a cloudy cornea. This neonate should also be evaluated for ✔neurofibromatosis A term neonate with meconium stained fluid who was resuscitated at birth has labored breathing. Retractions and respiratory grunting are present. An arterial blood gas reveals: pH 7.23; PCO2: 49 mm Hg; PO2: 36 mm Hg; HCO3: 19 mEq/L. This blood gas represents: ✔mixed acidosis Infants with Beckwith-Wiedemann syndrome have a high risk for which anomaly? ✔Omphalocele A neonate is born with a cavernous hemangioma. The parents are concerned about the cosmetic effect of this skin disorder. The nurse practitioner should advise that ✔involution will begin to occur around 1 year of age The potent stimulant of smooth muscle contraction that is essential for ductus arteriosus closure is ✔increase in pO2 When performing a gestational age assessment, the nurse practitioner should recognize that a finding that correlates with advancing gestational age is increased ✔resistance with scarf sign maneuver An important principle action of epinephrine during resuscitation is to ✔promote peripheral vasoconstriction What is the appropriate dosage for ETT epinephrine? ✔0.5 to 1.0 mL/kg What is the appropriate dosage for IV epinephrine? ✔0.1 to 0.3 mL/kg Prophylactic use of surfactant has been demonstrated to reduce ✔pneumothorax The mother of a newborn with a post-operative gastroschisis repair expresses concern about the nurse's use of a pacifier for her infant. The nurse practitioner explains that ✔non-nutritive sucking reduces pain ✔volume expanders Neonatal Bartter Syndrome is an inherited disorder characterized by ✔electrolyte imbalance and dehydration Criteria for successful weaning from an incubator to an open crib include that the infant ✔is medically stable The greatest risk for maternal transmission of HIV is ✔intrapartum The pattern of care provided to a neonate should be based on ✔the infant's cues and needs so caregiving can be initiated when the infant can best tolerate it An asymptomatic mother's hepatitis screen reveals that she is HBsAg positive. This neonate ✔should have post immunization serologic testing for anti-HBs An advantage of a skin servo-controlled incubator is ✔more effective neutral thermal environment A postpartum breastfeed mother is prescribed a category L3 medication. The clinician should understand with regard to the infant this category means ✔No controlled studies and possible risk In an institution the probability of failure-free performance over a specific time frame is known as ✔reliability A neonate is on a ventilator for respiratory distress syndrome. Ventilator settings are: PIP: 26; PEEP: 5; FiO2: 1.0; Rate: 40, SaO2 90.The neonate is given surfactant, and 18 hours later, the ventilator settings are: PIP: 18; PEEP: 4; FiO2: 0.21; Rate 20, SaO2 95. The nurse practitioner should recognize that ✔the neonate should be extubated to nasal CPAP Heart sounds indicative of aortic stenosis include ✔a harsh grade IV systolic murmur Pro-coagulation factors II, VII, IX and X are activated by ✔vitamin K C-Reactive protein is believed to be a ✔carrier protein involved in removing foreign materials from damaged tissues A woman who is breastfeeding inquires as to if she will be able to take her annual flu shot this year. The nurse should inform her that breastfeeding will have which of the following effect on the flu vaccine. ✔There is no effect on the vaccine or the milk production. Fixed position of the eyes during rotation of the head indicates ✔brain stem dysfunction X-ray findings of multiple air-filled cysts with over-distention, compression of the opposite lung and mediastinal shift is a description of ✔cystic adenomatoid malformation When a parent is to donate blood to their neonate for a blood transfusion, it is imperative that ✔parental blood components be irradiated before use An x-ray shows a double bubble and a small amount of distal intestinal air. Based on these findings, the infant is also at risk for ✔congenital heart disease Oxygen delivery in the neonate is enhanced by increased ✔hemoglobin A A 5 day old neonate becomes irritable, cyanotic and tachypneic. The nurse practitioner notices that when the infant cries, the cyanosis becomes more pronounced. The most likely origin of these symptoms is ✔cardiac A six day old neonate develops eyelid swelling with a purulent discharge. Gram negative intracellular diplococci are identified on gram stain. This conjunctivitis is caused by ✔gonorrhea