AACN CCRN® (Neonatal) Critical-Care Registered Nurse Neonatal Exam Prep 2024/2025, Quizzes of Neonatology

Download AACN CCRN® (Neonatal) Critical-Care Registered Nurse Neonatal Exam Prep 2024/2025 and more Quizzes Neonatology in PDF only on Docsity! AACN CCRN® (Neonatal) Critical-Care Registered Nurse Neonatal Exam Prep 2024/2025 ARE YOU READY TO TAKE YOUR NEONATAL NURSING SKILLS TO THE NEXT LEVEL? OUR COMPREHENSIVE AACN CCRN® (NEONATAL) EXAM PREP 2024/2025 STUDY GUIDE IS DESIGNED TO HELP YOU EXCEL ON THE EXAM AND ADVANCE YOUR CAREER. IA. Cardiovascular 1. A large ventricular septal defect (VSD) in a neonate results in which of the following? o Decreased pulmonary circulation o A harsh diastolic murmur heard over the lower left sternal border o Right-to-left shunting o Left-to-right shunting IE. Multisystem 2. For the placement of a peripherally inserted central catheter (PICC) in a neonate, a nurse should provide all the following interventions for neonatal pain relief, EXCEPT: o Nonnutritive sucking o Skin-to-skin/kangaroo care o Opioid administration o Swaddling, holding, and rocking IC. Endocrine, Hematology, Gastrointestinal, Renal, Integumentary 3. A nurse is caring for an infant with suspected Hirschsprung's disease. This infant will likely need to undergo which of the following diagnostic procedures? o Contrast enema, MRI, rectal biopsy o Contrast enema, abdominal x-ray, rectal biopsy o Blood work, CT scan, contrast enema o Abdominal x-ray, blood work, contrast enema II. Professional Caring & Ethical Practice 4. Decision-making in the NICU often relates to which concept? o Patienthood o Personhood o Professional-patient relationship o Informed consent II. Professional Caring & Ethical Practice 5. Which of the following aspects of family-centered care (FCC) is considered to be foundational? o Fully informed parental decision-making o Parental advance directives o Effective communication o Collaborative relationships ID. Musculoskeletal, Neurology, Psychosocial 6. An infant is born via an uncomplicated vaginal delivery with cranial swelling and warmth, a noted intracranial bruit, and high-output congestive heart failure with an anatomically normal heart What is the MOST likely diagnosis? o Cavernous hemangioma o Cephalohematoma o Kaposiform hemangioendothelioma (KHE) o Arteriovenous (AV) malformation IB. Respiratory 7. Meconium aspiration syndrome (MAS) is associated with which of the following pathophysiologic mechanisms? o Uneven aeration, risk of air trapping and impaired gas exchange, and inactivation of surfactant o Hemodynamic impairment and restricted chest and diaphragmatic movement o Gas interstitium compressing the alveoli, airways, and pulmonary venules o Lungs prone to atelectasis becoming susceptible to volutrauma IA. Cardiovascular 8. For neonates, in which of the following congenital heart defects is cyanosis ALWAYS present to varying degrees? o Providing ongoing positive feedback to parents o Adhering to NICU visiting policies and rules o Relinquishing control to parents, particularly at the bedside o Educating parents about their infant's medical condition IB. Respiratory 17. What are the usual effects of increasing the RATE of mechanical ventilation in a neonate? o Increased PaO2, decreased PaCO2, increased pH o Decreased PaO2, increased PaCO2, increased pH o Increased PaO2, decreased PaCO2, decreased pH o Decreased PaO2, decreased PaCO2, increased pH IE. Multisystem 18. Which condition is a type of pregnancy-induced hypertension that is accompanied by edema and proteinuria and generally develops during the second half of pregnancy? o Eclampsia o Gestational hypertension o Preeclampsia o Chronic hypertension in pregnancy IB. Respiratory 19. Magnesium sulfate (MgSO4) infusions are often administered to a mother in an effort to suppress premature labor. Why can these infusions pose a risk to the infant? o Fetal heart tones lose amplitude. o Fetal respiratory depression can occur. o Increased serum calcium levels can develop. o The infant may develop hypoglycemia and tachycardia. IA. Cardiovascular 20. The parents of an infant born with congenital heart disease (CHD) inquire why the heart defect was not detected on a fetal echocardiogram. What is the BEST response? o "About 15% of infants with an abnormal fetal echocardiogram are diagnosed with CHD after birth." o "It would be best to ask the neonatologist." o "The fetal heart is not fully examined during a fetal echocardiogram." o "A fetal echocardiogram detects under 50% of severe CHD cases." IC. Endocrine, Hematology, Gastrointestinal, Renal, Integumentary 21. An infant is receiving a blood transfusion. Once opened, blood bags should not be used for more than which period? o 6 to 8 hours o 10 to 12 hours o 4 to 6 hours o 8 to 10 hours 1. Correct Answer: Left-to-right shunting Explanation: VSDs are the most common congenital heart defect. At 2 per 1,000 live births, VSDs are the most common of all CHDs, accounting for 37% of all congenital heart disease. A large VSD allows significant left-to-right shunting; pulmonary vascular resistance (PVR) is less than systemic vascular resistance (SVR), causing a left-to-right shunt. Highly oxygenated blood returning from the lungs is shunted across the defect and back to the lungs. This pulmonary overcirculation results in CHF, pulmonary edema, respiratory distress, and failure to thrive. A pansystolic murmur can be heard over the left sternal border. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 855-857. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 477-478. 2. Correct answer: Skin-to-skin/kangaroo care Explanation: Evidence-based pain management strategies for PICC line insertion include oral nonnutritive sucking or a sucrose pacifier, swaddling, holding and rocking, topical numbing medications at the site of insertion such as EMLA cream or amethocaine gel, and opioid administration. Kangaroo care is not recommended for PICC line insertion. REFERENCE: CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 253-255. MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 303. 3. Correct answer: Contrast enema, abdominal x-ray, rectal biopsy Explanation: The diagnostic evaluation of Hirschsprung's disease, a congenital intestinal disorder caused by a lack of ganglion cells in the bowel wall which disrupts effective peristalsis, begins with a contrast (barium) enema. If the contrast enema is equivocal, an abdominal x-ray film should be obtained the following day to evaluate the extent of retained contrast material. Significant contrast material retained within the distal colon and rectum suggests the presence of Hirschsprung's disease. may occur with severe NEC or impaired gastroschisis. Pneumothorax and pulmonary interstitial emphysema result from gas interstitium compressing the alveoli, airways, and pulmonary venules. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 795. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 405-406. 8. Correct answer: Tricuspid atresia Explanation: In tricuspid atresia, there is complete agenesis of the tricuspid valve with no direct communication between the right atrium and right ventricle (i.e., no blood can flow from the right atrium to the right ventricle). Tricuspid atresia will always produce cyanosis in neonates, although the degree of cyanosis varies. Newborns will have marked cyanosis if the pulmonary blood flow is compromised. Oxygen saturations should be greater than 75% due to the complete mixing of oxygenated and deoxygenated blood within the heart. Coarctation of the aorta generally does not produce cyanosis in newborns with isolated events, but an oxygen saturation difference may be found between the upper and lower extremities. Unless another heart defect is present, goal saturations should be greater than 92%. AV septal defects may or may not present with mild cyanosis, particularly in the immediate neonatal period before the pulmonary vascular resistance has fallen. Goal saturations should be greater than 75% on room air. Cyanosis is generally not present in pulmonary stenosis but may occur in the presence of a right-to-left atrial shunt, and goal saturations are often greater than 85% due to decreased pulmonary blood flow. REFERENCE: CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 484-485. MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 870-872. 9. Correct answer: Two days Explanation: Infants born to HIV-infected mothers can convert within 48 hours; about 30% of HIV- infected infants have a positive DNA PCR assay from samples obtained within 48 hours of birth. Ninety-three percent of infants have detectable HIV DNA by two weeks, and almost all have it by a month of age. Tests must be repeated to ensure positive results one month after birth; the Western blot test is used for confirmation of positive ELISA results. HIV-infected infants can have multiple symptoms, including failure to thrive, developmental disabilities, neurologic dysfunction, hepatosplenomegaly, generalized lymphadenopathy, parotitis, persistent oral thrush, and chronic and recurrent diarrhea. In addition, these infants commonly experience osteomyelitis, septic joints, pneumonia, sepsis, meningitis, and otitis media with common organisms, and these infections may be recurrent. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 692-695. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 609. 10. Correct answer: Plain abdominal radiographs Explanation: An abdominal x-ray allows for the determination of bowel pathology such as a dilated stomach, a proximal duodenum, or rarely pneumoperitoneum in the presence of advanced intestinal necrosis. It is the initial diagnostic imaging study ordered. The definitive study for malrotation, which is a common cause of bilious emesis, is a UGI series. Since malrotation is considered a surgical emergency, an MRI may not be readily available and is not of significant diagnostic value. Abdominal ultrasound, although user-dependent, can be used to identify a midgut volvulus without the need to expose the infant to radiation. However, this modality is less sensitive for malrotation without volvulus. REFERENCE: CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 517. MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 208, 1010. 11. Correct answer: Parent and infant interaction is continuously assessed, and interactions are supported Explanation: Standards of critical care should focus on both infant and caregiver responses and interactions. Beginning at birth, daily caregiving and interactions such as feeding, diapering, holding, and playing with the parent or caregiver provide infants with reciprocal stimuli for further developing their identity. Infant development occurs within the framework of interaction with a caregiver and the family; interventions should be individualized for each infant and parent and adjusted based on ongoing assessments of infant cues and responses, as well as parental involvement and interaction. Parental support and bonding should be encouraged at every opportunity. REFERENCE: CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 179. MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 334-336. 12. Correct answer: Neutropenia Explanation: Ganciclovir, foscarnet, valganciclovir, and cidofovir are approved only for the treatment of life- and sight-threatening diseases. IV ganciclovir therapy for infants with CMV can prevent MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 1047-1050. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 181. 17. Correct answer: Decreased PaO2, decreased PaCO2, increased pH Explanation: There are usual effects to be expected from changing specific ventilator settings. With an increased rate on the mechanical ventilator, an infant usually experiences a decrease in PaO2, a decrease in PaCO2, and an increase in pH. A complication that could be caused by this change is respiratory alkalosis. When increasing PIP, usual effects include an increase in PaO2, a decrease in PaCO2, and an increase in pH. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 756. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 430. 18. Correct answer: Preeclampsia Explanation: Preeclampsia is a condition occurring in pregnancy characterized by high blood pressure, proteinuria, and edema, occurring after 20 weeks of pregnancy in women with or without preexisting hypertensive disease. Preeclampsia is often precluded by gestational hypertension, which is defined as hypertension arising during the second half of pregnancy in the absence of proteinuria. Preeclampsia is most common in primigravidae, obese women, and women with multiple gestations and molar pregnancies. It is also commonly seen in women with a family history of preeclampsia and pregestational diabetes mellitus. Eclampsia is the onset of seizures in a preeclamptic woman and is a rare and serious condition. Chronic hypertension in pregnancy is diagnosed either before pregnancy or before 20 weeks of gestation. Chronic hypertension is associated with IUGR, preterm birth, placental abruption, and stillbirth. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 31-32. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 24-26. 19. Correct answer: Fetal respiratory depression can occur. Explanation: MgSO4 is a medication used to suppress premature labor and is given to a mother when delivery would result in premature birth. It works by decreasing muscle contractibility, thereby inhibiting uterine activity and effectively interrupting preterm labor. Neonatal consequences of maternal magnesium administration include respiratory depression, decreased muscle tone and drowsiness, and possibly decreased serum calcium levels. Hypoglycemia and tachycardia in infants are not associated with maternal MgSO4 administration, and fetal heart tones are not likely to lose amplitude. REFERENCE: CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 29. MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 33. 20. Correct answer: A fetal echocardiogram detects under 50% of severe CHD cases. Explanation: Fetal echocardiograms are routinely done on mothers with a history that suggests CHD. A family history of CHD, fetal malformations on routine prenatal ultrasounds, abnormal fetal heart rhythm, maternal insulin-dependent diabetes, or exposure to unknown teratogens are also possible indications for a fetal echocardiogram. The recommended timing for a fetal echocardiogram is between 18 and 20 weeks of gestation, although a detailed cardiac evaluation and an accurate CHD diagnosis can be made as early as 12 weeks of gestation. Unfortunately, under half of children with severe CHD receive a prenatal diagnosis (30% to 50% of severe CHD is detected before birth). REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 839-841. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 473-474. 21. Correct answer: 4 to 6 hours Explanation: Blood bags should not be used for more than four hours after opening (six at the absolute most). In addition, vital signs should be obtained and recorded every 15 minutes during blood transfusions, and careful observations should be made for reactions, including increased temperature, diaphoresis, irregular respirations, bradycardia, restlessness, and pallor. If any of these findings are observed, transfusions should be stopped immediately. REFERENCE: MERENSTEIN & GARDNER'S HANDBOOK OF NEONATAL INTENSIVE CARE: AN INTERPROFESSIONAL APPROACH 9TH EDITION. PG 632-635. CORE CURRICULUM FOR NEONATAL INTENSIVE CARE NURSING 6TH EDITION. PG 583.