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Book 3 Unit 1

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Which of the following procedures is the best way to measure the concentration of arterial oxygen?
A baby with respiratory distress is breathing 45% oxygen and has an arterial blood oxygen tension of 96 mm Hg. What adjustments in oxygen should be made for this baby?
A baby's eyes may be damaged from periods of too much
Which of the following procedures is the best way to gauge the amount of oxygen a baby needs?
Which of the following babies is least likely to require supplemental oxygen?
Which of the following techniques is the best way to regulate the amount of oxygen a baby receives?
A baby found in mother's room with bluish-colored tongue and lips requires immediate oxygen therapy.
Arterial blood gas samples are not needed if continuous pulse oximetry is used.
Lung damage is a possible consequence of high inspired oxygen concentration over time .
Capillary blood gas measurements are a reliable way to determine a baby's blood oxygen level.
Oxygen from a tank that has been in a warm room for more than 24 hours does not need to be heated or humidified.
A pulse oximeter uses light to estimate the degree to which hemo- globin is saturated with oxygen.
Pulse oximetry is most sensitive in the detection of low blood oxygen.
Book 3 Unit 2

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
To determine if a baby is cyanotic , which of the following body parts is the best part of the baby's body to examine?
A baby's respiratory rate is 70 breaths per minute. This breathing pattern is called
What causes respiratory distress syndrome in the newborn?
Which of the following babies is not at increased risk for respiratory distress?
A baby has respiratory distress. You note asymmetrical movement of the chest, with breath sounds louder on the left side. Which of the following actions is most appropriate for this baby?
If a preterm baby stops breathing for 10 seconds, this is considered
Which of these may be a cause of apnea?
(Choose the letter that identifies the correct answers.)
1. Imbalance in blood chemistry, such as low blood glucose, calcium, or sodium level
2. Infections
3. Low blood volume
4. Temperature change, such as when a cold baby is being warmed
A baby with respiratory distress has an apneic spell. What should you think about this?
What percentage of babies weighing less than 1,000 g (<2lb 3oz) will have at least 1 apneic spell?
When a baby is assisted with ventilation for an apneic spell, it is important to the rate of assisted breathing before stopping assistance
Three hours after birth, a baby shows mild grunting and nasal flaring . This is probably expected.
Babies frequently cannot breathe through their mouths by themselves .
A baby in respiratory distress who is grunting probably has poor lung compliance ("stiff lungs").
Which of the following babies is at highest risk for developing a pneumothorax?
A baby with a pneumothorax is least likely to develop
The possible consequences of a pneumothorax include all of the following condi­tions, except
Approximately of healthy term newborns will develop a pneumothorax.
A pneumothorax should be considered anytime there is a sudden deterioration in a baby's condition, even if the baby is recovering from an illness.
Book 3 Unit 3

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Image or umbilical cord
Above is an illustration of an umbilical cord. What is the structure labeled X?
If a baby needed emergency medication in the delivery room, you would give the medication through an
If a baby needed monitoring of blood oxygen, carbon dioxide, and pH levels, you would obtain blood samples from an
Which of these dangers are possible with an umbilical venous catheter?
   
Yes No
 
 
 
 
 
An umbilical venous catheter should be left in place until a baby is well.
If a constant infusion is to be given through an umbilical arterial catheter, an infusion pump must be used.
Umbilical venous catheters are most appropriately used for
You are inserting an umbilical arterial catheter in a baby. The baby's toes on his right foot suddenly turn white. What should be done?
Book 3 Unit 4

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Blood pressure occurs as a result of
A palpation blood pressure most closely approximates the
What is the recommended initial dosage of fluids to increase the blood volume of a 2,000-g (4 lb 6Y2 oz) baby who is in shock?
Which of the following amounts is the best estimate of the total blood volume of a 2,000-g(4 lb 6Y2 oz) baby?
What minimum amount of blood loss would put a 2,000-g (4 lb 61h oz) baby into shock?
Which of the following fluids is the best fluid to use to restore a baby 's blood volume?
What can happen to babies with low blood pressure?
If a term baby is born with a blood pressure of 26 mm Hg, the first action should be to crossmatch the baby's blood and administer compatible blood.
Low blood pressure in newborns is associated with all of the following conditions, except
Chart
Use the chart above to answer this question.
A baby weighing 1,800 g (4 lb) has a blood pressure of 32/12 mm Hg at 30 minutes of age. How would this baby's blood pressure be described?
Book 3 Unit 5

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Which of the following babies should receive intravenous (IV) therapy?
   
Yes No
 
 
 
 
An umbilical venous catheter is appropriately inserted when a baby weighing 1,900 g (4 lb 3 oz) needs
Which IV fluid should be used during the first 24 hours after birth for a baby with no specific complications?
How much fluid does a term baby need after the first 48 hours of postnatal age?
At 2 days of age, a baby's sodium level is 150 mEq/L. This may indicate that the baby is receiving too much fluid.
A baby who is designated to receive nothing by mouth has been receiving IV ther­apy for 4 days. Which test(s) should this baby routinely receive?
A 6-day-old, 2,500-g (5 lb 8 oz) baby is receiving the targeted amount of IV and/or oral fluid. How much would you expect the baby's daily urine output to be?
Approximately how much IV fluid should a 2,700-g (5 lb 15 oz) baby receive during the third day after birth?
Book 3 Unit 6

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
In which of the following situations is a newborn most at risk for feeding intolerance?
Which of the following babies is most likely to develop feeding problems?
How does formula for preterm newborns differ from that for term newborns?
A 2-hour-old, term baby that is appropriate for gestational age has rapid, shallow res­ pirations at a rate of 80 breaths per minute. The baby is requiring only 30% oxygen. How would you provide fluids/nutrition for this baby?
A 2,000-g (4 lb 61h oz) baby who is small for gestational age will require more calories to grow than a 2,000-g baby who is appropri­ ate for gestational age.
Most preterm newborns initially lose weight and then slowly regain weight to arrive at their birth weight by approximately 2 weeks of age.
Preterm newborns born prior to 34 weeks of gestation have higher protein, vitamin, and mineral needs and often require fortified human (breast) milk until they are ingesting more liberal volumes.
Which of the following babies require tube feedings instead of nipple feedings?
Which of the following procedures should usually be performed before each tube feeding?
The placement of a feeding tube should be checked before every feeding.
Term babies with increased work of breathing and supplemental oxygen requirement may be fed orally.
A combination of nipple and tube feedings may be appropriate for some babies.
Book 3 Unit 7

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
In an otherwise healthy baby, which of the following bilirubin levels would be of most immediate concern to you?
For which of the following babies would you expect the binding capacity of serum protein for bilirubin to be least affected?
When a baby is jaun diced, which of the following actions is the first you should take?
Visible jaundice appearing within 24 hours of birth is usually
Newborns are more likely than adults to have hyperbilirubinemia because
The bilirubin of babies with very low Apgar scores may be dangerous at bilirubin level than for a baby with high Apgar scores.
All of the following complications are possible results of phototherapy, except
All of the following laboratory tests are routine in the investigation of hyperbilirubine­ mia, except
Which of the following babies should receive intravenous (IV) therapy?
   
Yes No
 
 
 
 
 
All jaundiced babies should receive phototherapy
Jaundice associated with breastfeeding is seen only during the first 3 days after birth.
Sepsis increases the risk from hyperbilirubinemia
Book 3 Unit 8

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Which of the following signs most commonly indicates a newborn has a systemic infection?
Which of the following statements is true?
Of the following procedures, what is the first thing that should be done for a baby suspected of having a systemic infection?
Which of the following procedures is most effective in controlling the spread of infection in the nursery?
What is one reason babies become infected more often than adults?
Babies with mild localized staphylococcal infections require only mild soap and water washes of the affected area and application of an antibiotic ointment.
An umbilical arterial catheter increases a baby's risk for infection
Neonatal group B 13-hemolytic streptococcal sepsis is rarely a life­ threatening infection
Even if a baby shows no sign of infection, congenital syphilis should be treated with intravenous antibiotics for 10 to 14 days.
Hepatitis B virus vaccine is recommended only for babies with mothers who test positive for hepatitis B surface antigen.
Antiretroviral treatment of HIV-positive women during pregnancy and labor can dramatically reduce the number of babies who become infected with HIV.
Gonococcal conjunctivitis is a localized infection that requires sys­temic antibiotic treatment
For each of the following conditions, determine if it places the baby at risk for devel­ oping an infection :
   
Yes No
 
 
 
For each of the following conditions, determine if it places the baby at risk for devel­ oping an infection :
   
Yes No
 
 
 
 
 
 
Book 3 Unit 9

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
A 4,000-g (8 lb 13 oz) baby girl is born in your hospital to a woman who was diag­nosed with glucose tolerance outside reference range at 24 weeks of gestation. She underwent cesarean delivery at 36 weeks because of stress test results outside reference range. The Apgar scores of the baby were 8 at 1 minute and 9 at 5 minutes. The baby is pink and active, with the following vital signs: pulse, 140 beats per minute; respirations, 40 breaths per minute and unlabored; temperature, 36.5°C (97.7°F); blood pressure, 46/36 mm Hg. What should be done for this baby?
   
Yes No
 
 
 
 
 
It is quite likely this baby is
   
Yes No
 
 
 
 
The baby is at risk for developing
   
Yes No
 
 
 
 
 
At 2 hours of age, the baby's vital signs are within reference ranges and she con­tinues to look well. By this time, assuming that no further information is available, which of the following actions should have been taken already or would now be appropriate to take?
   
Yes No
 
 
 
 
 
 
An 1,800-g (3 lb 151h oz). 3-day-old baby with an estimated gestational age of 33 weeks has been in your care in the nursery. She has been feeding well, has had no respiratory problems, and is appropriate size for gestational age. Because of her size and gestational age, she has been continuously connected to a cardiorespiratory monitor. Between feedings, she suddenly becomes apneic, cyanotic, and limp, with a heart rate of 50 beats per minute. She does not resume breathing with vigorous stimulation . <br>For each item, mark the line in the one most appropriate column .
   
Do Immediately Do in Next Several Minutes Not Indicated
 
 
 
 
 
 
 
 
 
What are the possible reasons for this baby's difficulties?
   
Yes No
 
 
 
 
 
Book 3 Unit 10

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
A 1,500-g (3 lb 5 oz) baby is born with Apgar scores of 5 at 1 minute and 9 at 5 minutes, and the decision is made to transport her to a regional perinatal center. While you are waiting for the regional center transport team to arrive, she develops severe respiratory distress with retractions and cyanosis. Which of the following actions should happen within the next several minutes?
   
Yes No
 
 
 
 
 
 
The baby continues to retract with respirations. Arterial blood gas results show Pao2 below 35 mm Hg, Paco2 of 70 mm Hg, pH level below 7.15, and HC0 3- of 22 mEq/L. Which of the following actions is most appropriate?
A baby is born with choanal atresia. An oral airway was immediately inserted, and the baby's vital signs are now within reference ranges and stable. Before transfer to a regional perinatal center, which of the following actions should be taken for this baby?
   
Yes No
 
 
 
 
 
You suspect a baby has sepsis. You have obtained blood cultures and started the baby on anti biotics. Which of the following actions should also occur for this baby?
A 1,200-g (2 lb 10Y2 oz) baby is born in your delivery room . Apgar scores are 8 at 1 minute and 9 at 5 minutes, vital signs and color are within reference ranges, and there is no evidence of respiratory distress. Because of the baby's small size, plans are made to have the baby transported to a regional perinatal center. Which of these actions should be taken in your hospital by your staff, before the transport team arrives?
   
Yes No
 
 
 
 
 
 
The arterial blood gas analysis in a baby receiving 40% inspired oxygen shows Paco2 of 30 mm Hg, Pao2 of 42 mm Hg, pH level of 7.18, and HC0 3- of 11 mE q/L. What should be done for this baby?
   
Yes No
 
 
 
 
A preterm baby is born after the amniotic membranes have been ruptured for 30 hours. At the time of rupture, amniotic fluid was foul smelling. The baby has Apgar scores of 5 at 1 minute and 7 at 5 minutes. At 30 minutes of age, the baby has a severe apneic episode that requires resuscitation. A decision is made to trans­ port the baby to a regional perinatal center. Which of the following steps should be done now, before the regional center transport team arrives?
   
Yes No
 
 
 
 
 
 
 
 
A 4,500-g (9 lb 15 oz) baby is born to a woman with glucose tolerance outside reference range. He has Apgar scores of 9 at 1 minute and 10 at 5 minutes. At 45 min­utes of age, the baby has a blood glucose screening test result of Oto 25 mg/dl . A peripheral intravenous infusion of 10% dextrose is started, with improvement in the baby's condition . Plans are made to have the baby transported to a regional perinatal center. Which of the following actions should take place prior to arrival of the trans­port team?
   
Yes No
 
 
 
 
Babies who have experienced severe perinatal compromise require large amounts of fluid.
Book 3 Unit 11

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome (NAS), is a multisystem disorder caused by the abrupt discontinuation of chronic fetal exposure to substances used by the mother during pregnancy. Which of the following statements describes a sign or symptom shown to be specific for NAS/NOWS?
The risk, timing, and duration of NAS/NOWS depends on the type of substance used by the mother. Which of the following exposures is most likely to result in withdrawal signs and symptoms in the first 24 hours after birth
How long should a healthy term neonate who is at risk for NAS/NOWS be monitored in the hospital after birth?
Which of the following increases the risk and/or severity of developing NAS/NOWS in newborns exposed to in utero opioids?
While NAS is a clinical diagnosis, toxicological confirmation is necessary to be able to identify the exact type of substance used, as well as confirm and/or rule out expo­ sure to other licit and illicit substances. Which of the following statements regarding toxicology screening in the newborn is correct?
The Eat, Sleep, Console (ESC) approach was developed to assist in the monitoring and management of neonates with NAS. Which of the following statements regard­ing ESC is incorrect?
The use of the ESC approach to manage newborns with NAS/NOWS is associated with an increased risk of hospital readmission for NAS symptoms.
Nonpharmacological interventions are the preferred first-line treatment for NAS/NOWS and should be optimized prior to considerations of pharmacological treatment. Which of the following statements regarding nonpharmacological management approaches is incorrect?
Breastfeeding is contraindicated in neonates with NAS/NOWS
Establishing a safe care plan for neonates with NAS/NOWS is a federal mandate.