NRP STUDY QUESTIONS AND ANSWERS UPDATED 2024/2025 WITH CORRECT 100% VERIFIED/DETAILED ANSW, Exams of Nursing

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You have determined a baby needs resuscitation at birth. What are the initial steps of newborn care?

• CORRECT ANSWERS Within 30 seconds of birth:

1. Provide warmth
2. Dry baby
3. Stimulate w/ gentle tactile stimulation
4. Position head & neck
5. Clear secretions (Mouth 1st, then nose) The steps of intubation should ideally be completed within which duration? - CORRECT ANSWERS Within 30 seconds. What personnel should be available if emergent care is required? - CORRECT ANSWERS Full team of resuscitation qualified personnel able to perform:
6. Intubation
7. CPR
8. Emergency vascular access What is the pre-ductal SpO2 range for 1 minute of life? - CORRECT ANSWERS 60-65% Effective team functioning is critical in ensuring the best performance. Which of these characteristics is critical in team leaders? - CORRECT ANSWERS They should be able to maintain situational awareness. You have been called to attend a birth and are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help? - CORRECT ANSWERS Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation. After the initial steps of newborn care, a baby is apneic. What is the most important and effective action to take in the resuscitation of this baby? - CORRECT ANSWERS Provide PPV. Which statement describes recommended practice when using a pulse oximeter in the delivery room?

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A. Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation. B. Place the pulse oximeter sensor on the right foot and adjust the O2 concentration to achieve 100% O2 sats. C. Place the pulse oximeter sensor on the right hand and adjust the O2 concentration to achieve 100% O2 sats. D. Place the pulse oximeter sensor on the right foot and use the minute specific oxygen saturation target to guide oxygen supplementation. - CORRECT ANSWERS A. Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation. Which O2 PPV resuscitator:

• Doesn't require a compressed gas source
• Doesn't reliably deliver free-flow O2 via the mask
• Doesn't deliver CPAP to a breathing baby - CORRECT ANSWERS Self-inflating bag.

1. If volume expansion is required, what is the initial dose?
2. What fluids can be used? - CORRECT ANSWERS 1. 10 mL/Kg given over 5-10 minutes
3. 0.9% NS or O negative PRBCs (blood would be most appropriate if severe anemia is suspected) How long does it take a healthy newborn to have an SpO2 ≥ 90%? - CORRECT ANSWERS At least 10 minutes When is the time of birth documented? - CORRECT ANSWERS After the last fetal part emerges from the birthing person. What is the preductal SpO2 range for 5 minutes of life? - CORRECT ANSWERS 80-85% 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? - CORRECT ANSWERS Insert a laryngeal mask.

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You are at the resuscitation of a newborn who is gasping and has a heart rate of 60 beats per minute. What is the most important action you can take? - CORRECT ANSWERS Provide positive-pressure ventilation (PPV). If the newborn has respiratory distress and generalized edema, what condition can you expect? - CORRECT ANSWERS Pleural effusion.

1. What flow rate is used for free-flow O2 administration?
2. What % of O2 do you start at? - CORRECT ANSWERS 1. 10 L/min
3. Start at 30%, then titrate up to desired SpO2 target range. When clearing secretions, which do you clear first: mouth or nose? - CORRECT ANSWERS Mouth (M comes before N) What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)? - CORRECT ANSWERS 2. mm Your team attends an emergency cesarean delivery of a term 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? - CORRECT ANSWERS Start PPV and check heart rate response after 15 seconds During the resuscitation of a newborn, you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? - CORRECT ANSWERS 100 bpm You are part of a team preparing for the birth of a baby who has meconium-stained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be: - CORRECT ANSWERS Present at birth. You are at a delivery of a baby born through meconium-stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? - CORRECT ANSWERS The baby should be brought to the radiant warmer for initial steps of newborn care.

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What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps? - CORRECT ANSWERS Administration of PPV that inflates the lungs What is the pre-ductal SpO2 range for 3 minutes of life? - CORRECT ANSWERS 70-75% If a heart rate is 9 beats in 6 seconds, how fast is the heart rate? - CORRECT ANSWERS 90 bpm Which O2 PPV resuscitator:

• Requires a compressed gas source
• Must have a tight seal to inflate
• Use a flow-control valve to regulate the PIP and PEEP
• Can deliver free-flow O2 via mask
• Can deliver CPAP to a spontaneously breathing newborn - CORRECT ANSWERS Flow-inflating bag What is the pre-ductal SpO2 range for 2 minutes of life? - CORRECT ANSWERS 65-70%

1. What is acrocyanosis?
2. Is it normal? - CORRECT ANSWERS 1. A blue colour in the hands and feet without central cyanosis.
3. It is normal. Why are you more likely to intubate the right mainstem bronchus than the left? - CORRECT ANSWERS The right is wider and more vertical. What is the initial PPV O2 concentration for a newborn < 35 weeks? - CORRECT ANSWERS 21-30% What colour will the CO2 detector change to if the lungs are intubated? - CORRECT ANSWERS Yellow If a baby doesn't improve despite resuscitative measures or suddenly develops severe respiratory distress, what condition might you expect? - CORRECT ANSWERS Pneumothorax

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A newborn of 34 weeks' gestation is not breathing (apneic) at 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? - CORRECT ANSWERS 21-30% You have started positive-pressure ventilation for a newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation? - CORRECT ANSWERS A rising heart rate. A baby requires positive-pressure ventilation because she is not breathing (apneic), but she soon establishes spontaneous respirations and a heart rate over 100 beats per minute. Her oxygen saturation is lower than the target level when in room air, so you provide free-flow oxygen. Which of the following devices cannot reliably deliver free-flow oxygen? - CORRECT ANSWERS Mask of self- inflating bag. Which statement best describes normal transitional physiology at the time of birth? A. O2 sats via pulse ox is unreliable in the newborn and 100% O2 is recommended immediately after birth. B. Visual assessment of cyanosis is a reliable indicator of the baby's O2 sats. C. Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. D. The O2 sat normally rises to at least 90% by 2 minutes of life. - CORRECT ANSWERS C. Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. A baby is born at 34 weeks' gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps? - CORRECT ANSWERS 1. Initiative positive-pressure ventilation

2. Place a pulse oximeter sensor on the right hand or wrist
3. Consider starting cardiac monitoring If a heart rate is 14 beats in 6 seconds, how fast is the heart rate? - CORRECT ANSWERS 140 bpm What is the pre-ductal SpO2 range for 10 minutes of life? - CORRECT ANSWERS 85-95% What personnel are required for every birth? - CORRECT ANSWERS At least 1 person:
4. Qualified in newborn care.

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2. Able to provide PPV.
3. Who is only responsible for the baby. A full-term baby is born by emergency cesarean delivery because of fetal bradycardia (Category III fetal heart rate tracing). The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process? - CORRECT ANSWERS Initiate positive-pressure ventilation and check for increasing heart rate. What is the appropriate technique to stimulate a baby to breathe? - CORRECT ANSWERS Gently rub the baby's back or extremities. You are called to attend to a newborn at birth. At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with the birther or be moved to the radiant warmer for further assessment? - CORRECT ANSWERS 1. Is the baby term?
4. Does the baby have good muscle tone?
5. Is the baby breathing or crying? What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room? - CORRECT ANSWERS Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation. 8th Ed. update Your hospital is planning Neonatal Resuscitation Program® training and trying to decide who should be included. - CORRECT ANSWERS Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn. Which of the following is an indication for endotracheal intubation? A. The presence of meconium-stained amniotic fluid on the skin of a vigorous newborn? B. All premature newborns < 30 weeks GA. C. The need to administer CPAP.

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D. The need for positive-pressure ventilation lasting more than a few minutes. - CORRECT ANSWERS D. The need for positive-pressure ventilation lasting more than a few minutes. What size laryngoscope blade should be used to intubate a newborn with an estimated GA of 30 weeks & birth weight of 1200 g? - CORRECT ANSWERS Size 0 A full-term baby is born in the hospital lobby. He is apneic, despite positioning his head in sniffing position, clearing his airway, drying and providing tactile stimulation. You have emergency equipment including a self-inflating bag. When should you start PPV? - CORRECT ANSWERS Immediately. What is the IV dose of epinephrine for a newborn? - CORRECT ANSWERS 0.2 mL/Kg (0.02 mg/Kg) of 1:10000 epinephrine

• Give epi rapid push, then follow w/ 3 mL NS flush 8th Ed. update What condition presents with a small, recessed lower jaw and the tongue positioned further back so it obstructs the airway? (May also have a cleft palate) - CORRECT ANSWERS Robin's Sequence What is the pre-ductal SpO2 range for 4 minutes of life? - CORRECT ANSWERS 75-80% When is PPV indicated? - CORRECT ANSWERS If in the 1st minute of life there are:

1. Inadequate spontaneous respirations (gasping or apnea).
2. Heart rate < 100 bpm. A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to: - CORRECT ANSWERS Start PPV. During resuscitation, a baby is responding to positive-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 transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress? - CORRECT ANSWERS Left-sided pneumothorax.

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In addtion to standard NRP equipment preparation, what additional resources are needed for a very preterm birth? - CORRECT ANSWERS Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat. Which of the following may be associated with delayed cord clamping in vigorous preterm newborns? A. Increased intraventricular hemorrhage. B. Decreased need for blood transfusions. C. Decreased blood pressure. D. Increased incidence of necrotizing enterocolitis. - CORRECT ANSWERS B. Decreased need for blood transfusions. For a newborn weighing 2 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated? - CORRECT ANSWERS 0.4 mL (0.04 mg) 8th Ed. update A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action? - CORRECT ANSWERS Stop chest compressions & continue PPV. How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate? - CORRECT ANSWERS 60 seconds. What is the preferred method for assessing heart rate during chest compressions? - CORRECT ANSWERS ECG monitoring A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. What is a common cause of asymmetric breath sounds in an intubated baby? - CORRECT ANSWERS The endotracheal tube is inserted too deep. If a preterm birth is anticipated, at what temperature should the room be set? - CORRECT ANSWERS 23ºC to 25ºC (74° F - 77° F)

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After chest compressions with coordinated ventilations are started, when should the heart rate should be assessed? - CORRECT ANSWERS After 60 seconds. In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn? - CORRECT ANSWERS The newborn's parents. You are in the delivery room caring for a preterm 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 air. The baby's respirations are labored. Which of the following is an appropriate action? A. Administer CPAP at 5 cm H20 pressure. B. Provide supplemental O2 to rapidly increase the O2 sat > 95%. C. Administer PPV w/ an initial inflation pressure of 30-35 cm H2O. D. Provide vigorous stimulation on the back, trunk & extremities. - CORRECT ANSWERS A. Administer CPAP at 5 cm H20 pressure. You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby's subsequent care? A. Apnea & bradycardia are uncommon, self-limited & no further monitoring is required. B. Position the baby's legs higher than the baby's head to decrease the chance of neurological injury. C. Monitor blood glucose levels because of the risk of hypoglycemia after birth. D. Maintain the baby's body temperature above 38°C/100.4°F. - CORRECT ANSWERS C. Monitor blood glucose levels because of the risk of hypoglycemia after birth.

1. What is the compression-ventilation rate for resuscitation?
2. How many events should occur per minute? - CORRECT ANSWERS 1. 3 compressions to 1 breath ("1 and 2 and 3 and breathe...") every 2 seconds
3. 120 events/minute (90 compressions & 30 breaths) 8th Ed. update

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Does the newborn with meconium-stained fluids stay with the birthing person for the initial assessment if they have good tone and respiratory effort? - CORRECT ANSWERS Yes. Gentle suctioning of mouth and nose with a bulb syringe can be performed, if required. What are the 4 pre-birth questions? - CORRECT ANSWERS 1. What is the expected gestational age?

2. Is the amniotic fluid clear?
3. Are there any additional risk factors?
4. Plan for umbilical cord management 8th Ed. update How often can you give epinephrine? - CORRECT ANSWERS Every 3-5 minutes. What are the signs & symptoms of an abnormal newborn transition? - CORRECT ANSWERS - Apnea or tachypnea

• Bradycardia or tachycardia
• Decreased muscle tone
• Decreased O2 sat
• Decreased blood pressure When does the immediate newborn evaluation occur? - CORRECT ANSWERS The time between the birth and cord clamping. What time frame should be used to administer intravenous epinephrine? - CORRECT ANSWERS Rapid push, as quickly as possible. When are chest compressions indicated? - CORRECT ANSWERS When the heart rate remains less than 60 beats per minute after 30 seconds of PPV that moves the chest, preferably through an alternative airway. True or False: The approach to decisions in the newborn should be guided by the same principles used for adults and older children. - CORRECT ANSWERS True

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A baby born at 36 weeks' gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. When should you check the newborn's blood glucose level? - CORRECT ANSWERS His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal. A newborn requires complex resuscitation. You have 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? - CORRECT ANSWERS 1. Respirations

2. Heart rate
3. O2 saturation True or False: Compared to a term newborn, it is more difficult to achieve effective spontaneous ventilation when resuscitating and stabilizing an extremely premature newborn. - CORRECT ANSWERS True. Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? A. The baby's heart rate is 120 bpm after resuscitative efforts, but she is very pale. B. The baby heart rate is 120 bpm after resuscitative efforts & there is a history of extensive vaginal bleeding during labour. C. The baby's heart rate rapidly increases to 120 bpm with epinephrine but her pulses seem weak. D. The baby's heart rate remains 50 bpm after resuscitative efforts and pulses are weak. - CORRECT ANSWERS D. The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak. For a term infant who doesn't require resuscitation, what should you continue to monitor after the 5 Initial Steps of newborn care? - CORRECT ANSWERS - Breathing

• Tone
• Activity
• Colour
• Temperature

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What is the condition where the nasal airway is obstructed by bone or tissue and may be accompanied by cyclic episodes of obstruction, cyanosis & O2 desaturation when sleeping/eating but resolves with crying? - CORRECT ANSWERS Choanal atresia How far is a UVC inserted in a term newborn? - CORRECT ANSWERS 2-4 cm or until blood can be aspirated. How far do you compress the chest when performing newborn CPR? - CORRECT ANSWERS One third the anterior-posterior diameter of the chest.

1. What is the respiration rate when providing PPV?
2. How many events should occur per minute? - CORRECT ANSWERS 1. "Breathe - 2 - 3"
3. 40-60 breaths/minute Pre-ductal blood supplies what parts of the body? - CORRECT ANSWERS 1. Heart
4. Brain
5. Right arm What is the recommended concentration of epinephrine for resuscitation? - CORRECT ANSWERS 1:10000 (0.1 mg/mL) Which O2 PPV resuscitator:

• Requires a compressed gas source
• Uses adjustable dials to select PIP (initial 20-25 cm H2O to a max of 40) and PEEP (5 cm H2O)
• Can deliver free-flow O2 via a mask
• Can deliver CPAP to a spontaneously breathing newborn - CORRECT ANSWERS T-piece resuscitator What is the initial O2 concentration for PPV if the newborn > 35 weeks? - CORRECT ANSWERS 21% (room air)

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When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation? - CORRECT ANSWERS The option of providing comfort care can be considered. A woman is admitted at 24 weeks' gestation with rupture of membranes, maternal fever, and premature labor. The care team offers the parents counseling. What is likely to be helpful? - CORRECT ANSWERS Provide parents with accurate prognostic information using all relevant information affecting their baby's prognosis. What is the target axillary temperature range for the preterm newborn? - CORRECT ANSWERS 36.5ºC to 37.5ºC What personnel are required if risk factors are present for a birth? - CORRECT ANSWERS At least 2 people to manage only the baby

• May vary based on the risk factors, number of babies expected, hospital policies, etc.

1. What areas are affected by central cyanosis?
2. Is it normal? - CORRECT ANSWERS 1. The lips, tongue and/or torso appear blue.
3. No, it is abnormal. If not properly intubated, what colour will the CO2 detector be? - CORRECT ANSWERS Purple/blue.
4. What is the initial ventilation pressure for PPV?
5. What is the max? - CORRECT ANSWERS 1. 20-25 cm H2O
6. 40 cm H2O You are counseling a set of 17-year-old parents,whose baby is about to be born at 23 weeks' gestation. You have explained the chance of survival is low and that if the baby survives there is a high likelihood of long-term morbidity.The parents understand your discussion and clearly request that you provide life-sustaining treatment in the delivery room.How might you answer them? - CORRECT ANSWERS You assure them that, as the parents, they are the appropriate decision makers for their baby and you will support their decision.

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Premature newborns are vulnerable to hyperoxia.Which action is appropriate with a pulse oximeter and blender during and immediately following resuscitation of preterm babies? - CORRECT ANSWERS Adjusting the oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 10 minutes after birth. After what duration of time might it be reasonable to consider discontinuing resuscitation following complete resuscitation efforts with no detectable heart rate? - CORRECT ANSWERS 20 minutes. Should be individualized depending on patient and contextual factors. 8th Ed. update A 10-day-old, mechanically ventilated newborn suddenly develops bradycardia and low oxygen saturation, despite the oxygen concentration being increased to 100%. What is the first and the most important step in the resuscitation of this newborn? - CORRECT ANSWERS Assess and establish adequate ventilation. What is the ETT dose of epinephrine for the newborn? - CORRECT ANSWERS 1 mL/Kg of epinephrine with several PPV breaths to distribute. When would you move a newborn with meconium-stained fluid to the radiant warmer? - CORRECT ANSWERS Immediately if they are non-vigorous with a decreased/absent respiratory effort and/or poor muscle tone. If a term baby with meconium-stained fluid is non-vigorous at birth, what should you do? - CORRECT ANSWERS 1. Immediately move them to the radiant warmer to perform the 5 Initial Steps of newborn care.

2. Bulb suction the mouth and nose, as intubation for suctioning is not recommended.
3. Provide PPV if they are not breathing/gasping or the heart rate is < 100 bpm. If a baby has laboured breathing or persistent central cyanosis, what 4 things should you do? - CORRECT ANSWERS 1. Position and clear airway.
4. Monitor SpO2.
5. Supplement with O2 as necessary.

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4. Consider CPAP. True or False: The minute SpO2 levels of babies born by Caesarean section may be lower than they are for babies born vaginally. - CORRECT ANSWERS True. What does the M & R stand for in MR. SOPA? - CORRECT ANSWERS M - Mask adjustment R - Reposition airway (Try PPV then proceed to next step if no chest movement) What does the S & O stand for in MR. SOPA? - CORRECT ANSWERS S - Suction mouth & nose O - Open mouth (Try PPV then proceed to next step if no chest movement) What does the P stand for in MR. SOPA? - CORRECT ANSWERS P - Increase the pressure by 5-10 cm H2O until you have chest movement (Try PPV then proceed to next step if no chest movement) What does the A stand for in MR. SOPA? - CORRECT ANSWERS A - Alternative airway (ETT or LMA) insertion and assess for bilateral breath sounds, chest movement and if CO2 monitor changes to yellow. Insert OG. After completing the steps in MR. SOPA, what should you do? - CORRECT ANSWERS 1. Provide PPV with chest movement for 30 seconds.
5. Reassess heart rate. After providing 30 seconds of PPV with chest movement, you reassess the heart rate and it is greater than 100 bpm. What should you do next? - CORRECT ANSWERS Continue to provide PPV at a rate of 40-60 breaths/minute until the baby has spontaneous respiratory effort. After providing 30 seconds of PPV with chest movement, you reassess the heart rate and it is 75 bpm. What should you do next? - CORRECT ANSWERS Reassess ventilation and proceed with corrective steps (MR. SOPA) as needed.

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Consider alternative airway (ETT or LMA) and cardiac monitoring. 8th Ed. update After providing 30 seconds of PPV with chest movement, you reassess the heart rate and it is less than 60 bpm. What should you do next? - CORRECT ANSWERS 1. Reassess ventilation and proceed with corrective steps (MR. SOPA) as needed.

2. Place an alternative airway (ETT or LMA) if not already insitu.
3. Start cardiac monitoring, if not already in place.
4. If no improvement, increase O2 to 100% and start chest compressions. The condition of an intubated newborn deteriorates. Using the DOPE mnemonic, what situations should you consider to resolve this issue? - CORRECT ANSWERS D - Displaced ETT? (too far into or out of the trachea) O - Obstructed ETT? (blood, meconium, thick secretions) P - Pneumothorax? E - Equipment failure? (leak or disconnection from the ETT, PPV resuscitator unit, or compressed gas source) What size LMA can be used for most newborns < 5 Kg? - CORRECT ANSWERS Size 1 You attend the birth a baby with prenatally diagnosed congenital diaphragmatic hernia. After birth, what should you do first? - CORRECT ANSWERS Intubate the trachea and insert an orogastric tube into the stomach. After 60 seconds of chest compressions and PPV via an ETT with 100% O2, you reassess the newborn's heart rate. It is less than 60 bpm. After resuming chest compressions and PPV, what are some troubleshooting questions you could consider using the CARDIO mnemonic? - CORRECT ANSWERS C - Chest movement with each breath? A - Airway secured with an ETT or LMA? R - Rate of 3 compressions coordinated with 1 ventilation every 2 seconds? D - Depth of compressions = 1/3rd the AP diameter of the chest?

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IO - Inspired Oxygen at 100% through a PPV device? 8th Ed. update What are the components of post-resuscitation care? - CORRECT ANSWERS 1. Transfer to NICU or hospital if supplemental O2 or PPV required.

2. Monitor temperature.
3. Monitor blood glucose levels (give IV dextrose as required).
4. Monitor for apnea and bradycardia, as could indicate abnormal temperature, oxygenation, acid- base balance, blood glucose and/or serum electrolytes. True or False: Epinephrine delivered by ETT is more reliable than IV epinephrine. - CORRECT ANSWERS False. True or False: After a dose of epinephrine is delivered via an ETT, it requires several PPV breaths to distribute the medication. - CORRECT ANSWERS True. Describe the umbilical vein's location and appearance. - CORRECT ANSWERS There is 1 umbilical vein and it is often located at the 12 o'clock position. The vein is larger and thinned walled. Describe the umbilical arteries location and appearance. - CORRECT ANSWERS There are 2 umbilical arteries, often lying closely together and the position varies based on where cord is cut. The arteries are smaller with thicker walls. They carry deoxygenated blood that reflects the newborn's status. True or False: When an alternative airway becomes necessary, a cardiac monitor is recommended for the most accurate assessment of the baby's heart rate. - CORRECT ANSWERS True. 8th Ed. moves using a cardiac monitor, if available, earlier in the algorithm. True of False: For preterm newborns <32 weeks gestation, volume boluses that are given in the first days of life or rapidly or that exceed 10 mL/Kg can increase the risk of intracranial hemorrhage. - CORRECT ANSWERS True.

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8th Ed. update Using a cardiac monitoring earlier in the algorithm aids having a more accurate heart rate and decreases interruptions in chest compressions. Practitioners should remember that the heart can have electrical activity without muscle contraction that moves blood through the heart. What is this called and how can you verify this is occurring? - CORRECT ANSWERS Pulseless electrical activity (heart rate will be zero, like in asystole). Suspect PEA when the ECG shows a heart rate but the baby's condition deteriorates and there is:

1. No palpable pulsations in the umbilical cord
2. No audible heart sounds upon auscultation.
3. No signal on pulse oximetry (or it is alarming). 8th Ed. update Your team has provided face-mask PPV with chest movement x 30 sec. When is placement of an ETT strongly recommended? a) The baby's HR remains <100 bpm and isn't increasing. b) The baby's HR is between 60-100 bpm and the HR is increasing. c) The babys' HR >100 bpm and the baby is beginning to breathe. d) The baby's HR is >100 bpm and O2 sat is less than target range. - CORRECT ANSWERS a) The baby's HR remains <100 bpm and isn't increasing. During a delivery, when and where should a person with intubation skills be available? a) In the hospital and immediately available. b) In the delivery room or OR at every birth. c) Available on call at home. d) Available on call from a remote area of the hospital. - CORRECT ANSWERS a) In the hospital and immediately available.

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What are the primary methods of confirming ETT placement within the trachea? a) Continued central cyanosis and no mist in the tube. b) Auscultation of bilateral breath sounds and no air entry heard over the abdomen. c) Demonstration of exhaled CO2 and a rapidly increasing HR. d) Absence of crying and no abdominal distension. - CORRECT ANSWERS c) Demonstration of exhaled CO2 and a rapidly increasing HR. You are resuscitating a critically ill newborn with a HR of 20 bpm. The baby has been intubated and the ETT depth is correct. You can see chest rise movement with PPV and hear bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow. What is the likely reason for this? a) The ETT isn't in the trachea. b) Excessive ventilation pressure. c) Epinephrine contamination. d) Low cardiac output. - CORRECT ANSWERS d) Low cardiac output. According to NRP 8th ed. algorithm, at what point during resuscitation is a cardiac monitor recommended to assess the baby's HR? a) After chest compressions are performed for at least 2 min. b) When an alternative airway is inserted. c) Immediately after epinephrine is administered. d) Anytime pulse oximetry is used to assess O2 sats. - CORRECT ANSWERS b) When an alternative airway is inserted. Even brief interruptions of chest compressions may significantly reduce their effectiveness, but it is also important to assess the need to continue chest compressions. What is the preferred way to assess the heart rate during chest compressions? a) Briefly interrupt chest compressions every 30 sec. to auscultate the HR. b) Briefly interrupt chest compressions and palpate the brachial pulse.

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c) Briefly interrupt chest compressions every 60 sec. to assess the HR using the cardiac monitor. d) Briefly interrupt chest compressions to palpate the umbilical cord. - CORRECT ANSWERS c) Briefly interrupt chest compressions every 60 sec. to assess the HR using the cardiac monitor. Your team is resuscitating a newborn at birth. The heart rate is low and the baby has poor perfusion. Which is the preferred method to assess the heart rate? a) Cardiac monitor. b) Pulse oximeter. c) CO2 detector. d) Direct auscultation. - CORRECT ANSWERS a) Cardiac monitor. When are chest compressions indicated? a) When the HR is < 80 bpm. b) When the HR remains < 60 bpm after at least 30 sec. of PPV that moves the chest, preferably through an alternative airway. c) When the HR remains <100 bpm after 30 sec. of PPV that moves the chest, preferably through an alternative airway. d) When the HR remains <100 bpm despite PPV with 100% O2. - CORRECT ANSWERS b) When the HR remains < 60 bpm after at least 30 sec of PPV that moves the chest, preferably through an alternative airway. After 60 sec. of PPV coordinated with chest compressions, the cardiac monitor indicates a HR of 70 bpm. What is your next action? a) Stop chest compressions and continue PPV. b) Continue chest compressions and PPV. c) Stop chest compressions and PPV. d) Administer epinephrine while continuing chest compressions and PPV with 100% O2. - CORRECT ANSWERS a) Stop chest compressions and continue PPV.

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What is the recommended depth of chest compressions? a) 1/3 the AP diameter of the chest. b) 1/4 the AP diameter of the chest. c) 1/2 the AP diameter of the chest. d) 2/3 the AP diameter of the chest. - CORRECT ANSWERS a) 1/3 the AP diameter of the chest. During chest compressions, which of the following is correct? a) To coordinate compressions and ventilations, the compressor calls out "Breathe-2-3, Breathe-2- 3..." b) The compression to ventilation ration is 15 compressions : 2 ventilations. c) Most babies who require chest compressions will also require volume expander. d) To coordinate compressions and ventilations, the compressor calls out "1-and-2-and-3and breathe-and..." - CORRECT ANSWERS d) To coordinate compressions and ventilations, the compressor calls out "1-and-2-and-3and breathe-and..." Your team is resuscitating a newborn whose HR remains < 60 bpm despite effective PPV and 60 sec. of chest compressions. You have administered epinephrine IV. According to NRP 8th ed., what volume of NS flush should you administer? a) 0.5 mL. b) 1 mL. c) 3 mL. d) 5 mL. - CORRECT ANSWERS c) 3 mL. According to NRP 8th ed., what is the suggested initial dose for IV epinephrine (0.1 mg/1 mL = 1 mg/10 mL)? a) 0.02 mg/Kg (0.2 mL/Kg). b) 0.05 mg/Kg (0.5 mL/Kg).

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c) 0.1 mg/Kg (1.0 mL/Kg). d) 0.3 mg/Kg (3 mL/Kg). - CORRECT ANSWERS a) 0.02 mg/Kg (0.2 mL/Kg). When is the administration of a volume expander indicated during newborn resuscitation? a) The baby's HR is not increasing and there are signs of shock or a Hx of acute blood loss. b) Theh baby's HR is increasing but the color remains poor. c) The baby's HR is increasing but there is a Hx of acute blood loss. d) The baby's HR is > 160 bpm but there are no spontaneous respirations. - CORRECT ANSWERS a) The baby's HR is not increasing and there are signs of shock or a Hx of acute blood loss. Your team is caring for a term newborn whose heart rate is 50 bpm after receiving effective ventilation, chest compressions, and IV epinephrine administration. There is a Hx of acute blood loss around the time of delivery. You administer 10 mL/Kg of NS (based on the newborn's estimated weight). At what rate should this be administered? a) Over 1-2 min. b) Over 5-10 min. c) Over 15-30 min. d) Over 20-25 min. - CORRECT ANSWERS b) Over 5-10 min. How soon after administration of IV epinephrine should you pause compressions and reassess the baby's HR? a) 10-15 sec. b) 30 sec. c) 60 sec. d) 90 sec. - CORRECT ANSWERS c) 60 sec. You are called to the birth of a newborn at 30 weeks gestation. As you prepare your equipment, what concentration of O2 will you use initially if PPV is required?

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a) 21-30%. b) 40%. c) 60%. d) 100%. - CORRECT ANSWERS a) 21-30%. A baby is born at 26 weeks gestation. The initial steps of care, including gentle stimulation, have been completed and the baby is nearly 1 min. old. The baby is not breathing. What is the most appropriate next step? a) Begin CPAP at 5 cm H20. b) Begin PPV by mask. c) Stimulate more vigorously to initiate breathing. d) Administer free flow O2. - CORRECT ANSWERS b) Begin PPV by mask. Choose the appropriate step(s) to prepare for the birth of a newborn < 32 weeks GA. a) Prepare a size 1 laryngoscope and size 3.5 mm ETT in case intubation is required. b) Decrease the delivery room temp. to approximately 65-66 F (18.3-18.8 C). c) Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, a hat, and a skin temperature sensor. d) Set the O2 blender to 100% and the flow meter to 15 L/min and the suction to 100 mm Hg. - CORRECT ANSWERS c) Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, a hat, and a skin temperature sensor. A term newborn was born via emergency C/S in the setting of fetal bradycardia. The baby was limp and bradycardic at birth and was intubated at 6 minutes after birth for persistent apnea. The cord blood gas demonstrates a severe metabolic acidosis, and the physical examination is consistent with hypoxic-ischemic encephalopathy (HIE). Which of the following is the most appropriate intervention for this newborn? a) Admit the newborn to a center with capability to perform therapeutic hypothermia.

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b) Maintain a body temperature >38 C avoid cold stress after resuscitation. c) Initiate formula feeding promptly to avoid electrolyte abnormalities. d) Administer 100% O2 and sodium bicarb to prevent pulmonary HTN. - CORRECT ANSWERS a) Admit the newborn to a center with capability to perform therapeutic hypothermia. A term baby was vigorous at birth but receives CPAP for 3 min. after birth for grunting respirations. The baby is now 15 minutes old, breathing comfortably in room air, and bonding with their mother. The team plans for the baby to room-in with their mother. What immediate decision needs to be made regarding post-resuscitation care? a) Determine who the baby's pediatrician will be after discharge. b) Decide how long the baby should stay in the hospital before discharge. c) Identify who will continue to monitor the baby in the mother's room. d) Determine which vaccines the baby will receive in the hospital. - CORRECT ANSWERS c) Identify who will continue to monitor the baby in the mother's room. A baby's HR does not increase after intubation 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? a) Oral mass. b) Neck mass. c) ETT inserted into the right mainstem bronchus. d) Robin sequence. - CORRECT ANSWERS c) ETT inserted into the right mainstem bronchus. During resuscitation, a baby is responding to PPV with a rapidly increasing HR. Her HR and O2 sats suddenly worsen. She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side. What is the most likely cause of this distress? a) Obstruction of the ETT with thick secretions. b) Displacement of the ETT from the trachea into the esophagus. c) Choanal atresia.

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d) Left-sided pneumothorax. - CORRECT ANSWERS d) Left-sided pneumothorax. You attended the birth of a baby with prenatally Dx severe congenital diaphragmatic hernia. What are the most appropriate steps as you begin your resuscitation? a) Begin face-mask ventilation and insert an OG into the stomach. b) Intubate the trachea and insert an OG into the stomach. c) Start CPAP and stimulate the baby. d) Obtain IV access and administer epinephrine. - CORRECT ANSWERS b) Intubate the trachea and insert an OG into the stomach. A woman in labour received opioid medication for pain relief 1 h before delivery. The baby does not breathe spontaneously and remains apneic after stimulation. What is your next intervention? a) Start PPV. b) Administer naloxone (Narcan). c) Continue vigorous stimulation. d) Administer bicarbonate. - CORRECT ANSWERS a) Start PPV. In most cases, who are the usual and appropriate surrogate decision makers for a newborn? a) The hospital chaplains. b) The newborn's parents. c) The members of the health care team. d) The hospital ethics committee. - CORRECT ANSWERS b) The newborn's parents. When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation? a) The option of providing comfort care can be considered.