RNC NIC Exam Questions With 100% Correct Answers 2023, Exams of Advanced Education

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RNC NIC Exam Questions With 100%

Correct Answers 2023

GIR - Correct Answer-6-8mcg/kg/min caloric intake D10 Bolus - Correct Answer-2mL/kg Fluid Volume Bolus - Correct Answer-10mL/kg Term Parenteral Fluid Requirement - Correct Answer-80mL/kg/day Enteral 100-150 mlk/kg/day Preterm Parenteral Fluid Requirement - Correct Answer- Enteral 150-200ml/kig/day GIR Calculation - Correct Answer-(%dextrose x IV rate) / (6 x wt in kg) I/T ratio - Correct Answer-%Metas + Bands / %Metas + Bands + Segs I/T ratio greater than >0.2 to >.25 suggestive of infection

0.8 associated with shock Absolute Neutrophil COUNT - Correct Answer-WBC x (%) Segmented neutrophils + band neutrophils + metamyelocytes Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent) 15,000 x .53 = 7950 ANC <1800 suggestive of infection Normal Range Mature WBCs - Correct Answer-Poly, Segs, Neutrophils Immature WBCs - Correct Answer-Meta, Bands, Stabs Platelet Range - Correct Answer-150-400k Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral infection, but usual onset does not occur until 1 to 3 days after infection onset (late indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver function test results, and l ow p latelet count), pregnancy-induced hypertension, and intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18, and 21, Turner's syndrome, and hemolytic disease.

CRP level - Correct Answer-CRP level usually <1.6 for the first two days of life Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged rupture of membranes. Most common pathogens - Correct Answer-Currently, GBS E. coli Candidas - Correct Answer--Diaper dermatitis presents with intense erythema and satellite lesions. -Congenital candidiasis presents with widespread erythematous maculopapular rash, and preterm infants may present with pneumonia. Congenital CMV infection - Correct Answer-congenital infection include: intrauterine growth restriction, hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly, hydrocephalus, intracerebral calcifications, hearing loss, chorioretinitis, and optic atrophy. Endotracheal Measurement - Correct Answer-6 + wt in kg Proper placement on an endotracheal tube is midway between the thoracic inlet and the carina. Polyethelane Wrap for Infant < 29 weeks - Correct Answer-Dry infants head only Place infant in bag, from neck down Remove bag once infant is in an NTE and humidified environment UAC Placement - Correct Answer-High Placement T6-T Low Placement L3-L UVC Placement - Correct Answer-1 to 2cm above the diaghragm Low Lying 2-4cm in the cord Chest Tube Placement - Correct Answer-Mid Clavicular line with distal chest tube hole inside the thoracic space lecithin/sphingomyelin (L/S) ratio - Correct Answer-An L/S ratio greater than 2:1 is considered to indicate fetal lung maturity. Anatomic events Five stages of lung development - Correct Answer-1. Embryonic development (weeks 1 to 5). The endoderm-derived embryonic foregut provides a single lung bud that begins to divide ventrocaudally through the mesenchyme surrounding the foregut. The pulmonary vein develops and extends to join the lung bud. The trachea develops at the end of the embryonic period. There are three divisions on the right side and two on the left side that will eventually become the lobes of the lungs.

2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage appears; main bronchi are formed; demarcation of major lobes occurs; formation of new bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no connection made with terminal air sacs. The lung at this time undergoes 14 more generations of branching and the formation of the terminal bronchioles. The lung resembles an exocrine organ because of surrounding loose mesenchymal tissues, hence the name pseudoglandular.
3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e., respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for surface-active material storage are seen; capillaries invade terminal airway walls; type II alveolar epithelial cells appear. Airway changes from glandular to tubular and increases in length and diameter. Vascular system proliferates and the capillaries are now closer to the epithelium-conducting airways. Respiratory bronchioles that will participate in gas exchange can be differentiated.
4. Terminal sac period (weeks 26 to birth). Around week 26 alveolar sacs are formed; air-blood surface area is limited for gas exchange; and type II cells are unable to release surfactant in sufficient quantity to maintain air breathing. Capillary loops increase; type II cells cluster at alveolar ducts, become numerous and mature; more budding occurs from alveolar ducts; and lung size increases rapidly because there is an exponential increase in surface area for gas exchange.
5. Alveolar period (week 32 to 8 to 10 years). This phase is characterized by continued alveolar proliferation and development. IUGR asymmetrical - Correct Answer-Weight low for Gestation Age Head Sparing (less restriction on brain growth) Old man appearance Appear wasted, thin Results from: Poor Placental function Maternal Hypertension* Smoking IUGR Symmetric - Correct Answer-Lower weight, height, length, and head circumference for gestational age Results from intrauterine viral infection, chromosomal genetic abnormalities, long standing disease Prostaglandin E1 (alprostadil) - Correct Answer-Prevent premature closure of the PDA Side Effects: Apnea, hypotension, hyperthermia, bradycardia Indomethicin (NSAID - Correct Answer-1. Hypoglycemia
6. Platelet dysfunction

3. Gastrointestinal perforation w/ steroids
4. Renal effects, decreases urine output! Used if PDA fails to close to prevent pulmonary over circulation and PPHN Diuretics effects - Correct Answer-1. Metabolic Alkalosis
5. Ototoxicity
6. Decreased calcium absorption in bones Theophylline - Correct Answer-Bronchodilator. Opens airways. Short half life, caffeine preferred treatment due to longer half life and more tolerable side effect profile. Digoxin - Correct Answer-Enhances contractility Inhibits Na + K+ ATP Reduces HR, CI'd if HR < Hypokalemia increases drug concentration Most frequent disorder associated with downsyndrome - Correct Answer-Deudonal Atresia Double Bubble May see VSD, AV Canal, Tetralogy of Fallot Upper GI Gold Standard for - Correct Answer-Malrotation Position for gastroschesis - Correct Answer-Lateral (side lying) to prevent occlusion of the mesenteric arteries that supply blood to the bowel. Tie bag to the axilla. VACTERAL, associated with what two disorders? - Correct Answer-TEF/EA vertebral defects anal atresia cardiac anomalies trachoesophageal fistula radial defects renal and limb anomalies Hirschbrung Disease - Correct Answer-Starts in distal rectum Clinical sign : failure to pass meconium within first 24-48 hours May be associated with bilious emesis and a distended abdomen Associated with CF Types of test to determine diagnosis: Barium enema, biopsy of rectum Congenital Diaphragmatic Hernia - Correct Answer-Space occupying lesion, intestinal contents fill the lung cavity

Presents with a scaphoid abdomen, barrel chest Can result in pulmonary hypoplasia, pulmonary hypertension Requires intubation, HFOV, ECMO Insert OG or NG tube CPAP is Contraindicated! Clinical Signs of Pyloric Stenosis - Correct Answer-Dehydration Non bilious projectile vomiting Peristaltic waves in the epigastrium Electrolyte disturbances Diagnostic image test for cholestasis - Correct Answer-Hepatobiliary HIDA scan Clinical signs of Biliary Atresia - Correct Answer-Acholic stools, bronze undertones, dark urine, hepatosplenomegaly Double bubble - Correct Answer-Dudeonal Atresia Meconium Ileus - Correct Answer-Mechanical Obstruction of distal ilem due to intraluminal accumulation of thick menconium ** Predominant cause cystic fibrosis S/s - abdominal distention, bilious vomiting, failure to pass meconium 12-24 hours X-ray shows soap bubble or ground glass appearance of distal intestine Treatment: Hypertonic contrast water soluble enema Nephron develops at how many weeks Best indicator of GFR on lab is? - Correct Answer-Develops at 34 weeks Creatinine Clearance Bruit auscultation over liver - Correct Answer-Arteriovenous malformation VCUG - Correct Answer-Evaluate function and flow of kidneys Abnormal finding in infants = Vesicoureteral reflux Urine backflows from the bladder into the upper urinary tract Midgut volvulus - Correct Answer-Twisting and spiraling of entire gut around the superior mesenteric artery Vascular compromise, necrosis, perforation Upper GI study - Correct Answer-Evaluates structure and function of upper gi system containing:

1. the esophagus

2. the stomach Water soluble contrast solution is swallowed series of x rays under fluoroscopy Complications: vomiting, reflux, aspiration Do NOT do an upper GI series on TEF/EA Hydrops Fetalis - Correct Answer-Abnormal fluid in two or more fetal compartments such as peritoneum, pericardium, skin, pleura Caused by massive hemolysis , sensitized mother's antibody crosses the placenta and attaches to fetal red blood cells Perform thoracentesis, pericentisis TEF most common type, interventions - Correct Answer-Type Turner Syndrome - Correct Answer-Infants with Turner syndrome can present with cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a coarctation of the aorta. Supraventricular Tachycardia - Correct Answer-HR > Vagal Maneuvers:

1. Stimulate a gag
2. Suction at nasopharnx
3. Apply crushed ice to nose and forhead Adenosine - antiarrythmiac agent Drug restores normal sinus rhythm by allowing AV nodal conduction, interrupting its reentry patterns Rapid IV push (half life 5-10 seconds), follow up w/ 2-3mL sterile water Reactions: Bradycardia, hypotension, heartblock, dyspnea Situs Inversus totalis - Correct Answer-Liver located in the left abdomen Heart located in the right chest Infant of the diabetic mother - Correct Answer-May have CHD, Cardiomyopathy CHD defects include: TGA, VSD, COA IDM have respiratory issues, PPHN, RDS Could also have polycythemia (venous HCT >65%)

High glucose uptake and high metabolic rate cuases a cellular hypoxia, leading to an elevated erythropoietin level Hypocalcemia, hypomagnesemia result from a functional hypoparathyroidsm due to maternal magnesium loss Trisomy 21 (Down Syndrome) - Correct Answer-Definitive Features

1. Small size
2. short round head flat facial profile
3. Epicanthal folds
4. upslanting palepbral fissures
5. Brushfield spots
6. small earts
7. Protruding tongue, short narrow palate
8. Simian crease (line across hand)
9. Excess skin on back of neck *Duodenal atresia/umbilical hernia Trisomy 18 (edwards syndrome) - Correct Answer-Rocker bottom feet w/ protrusion of calcaneus Prominent occiput Clenched fists w/overlapping fingers third and fourth fingers(camptodactyly) Congenital heart disease Horseshoe kidneys Umbilical hernia Trisomy 13 (patua syndrome) - Correct Answer-1. microcephaly
10. CNS malformations
11. coloboma of the iris
12. postaxial polydactyly Turner Syndrome - Correct Answer-A chromosomal disorder in females in which either an X chromosome is missing
13. Short webbed neck
14. downslanted palpebral fissures
15. micrognathia
16. low set posterriorly rotated ears
17. broad thorax

CHARGE association - Correct Answer-- Colobomas (ocular tissue defects)

• Heart defects (
• Atresia of nasal choanae
• Retardation
• Genital anomalies

• Ear anomlies 22q11 deletion syndromes (DiGorge) - Correct Answer-1. Downslanting eyes

2. short philthrum
3. micrognathia
4. fish mouth Persistent hypocalcemia. Evaluate serum calcium and PTH Absence of thymus, T cell abnormalities Obtain a FISH chromosomal analysis Tetralogy of Fallot (Cyanotic Heart) - Correct Answer-Large VSD, right ventricular hypertrophy, right ventricular outflow tract obstruction (pulmonary stenosis), overriding aorta of the ventricular septum Severity of cyanosis depends on degree of right ventricular outflow tract obstruction Boot shaped heart Pink tet (acrocyanotic) - Correct Answer-Mild Pulmonary artery stenosis - blood flow to lung not restricted, blood shunts from left ventricle through vsd to pulmonary artery and lungs (left to right shunt), resulting in excessive pulmonary blood flow = acrocyanotic or pink tent Blue Tet - Correct Answer-Pronounced pulmonary stenosis , blood flow to lungs restricted Deoxygenated blood shunts from right ventricle through VSD to aorta (right to left shunt). Smaller amount of blood enters lungs, more blue than red entering aorta. Tet Spell - Correct Answer-Infants become irritable, pale, hypoxemic, flaccid Blood flow across the right ventricular outflow tract is decreased, right to left shunt through VSD out of aorta, bypasses lungs. Treatment = increase SVR to decrease right to left shunt at the VSD Place infant to knee to chest position, this will increase peripheral vascular resistance , thus reducing right to left shunt and increasing pulmonary blood flow. Administer to infant

A bedside immunoassay called AmniSure is performed. This test identifies a glycoprotein abundant in amniotic fluid. This glycoprotein is called: - Correct Answer- placenta α-microglobulin-1 (PAMG-1 protein) Biophysical Profile BPP - Correct Answer-fetal tone, fetal breathing, fetal movement, nonstress test, and amniotic fluid volume. Gestational age for testing diabetes - Correct Answer-24 to 28 weeks' gestation. A late deceleration is a reflex fetal response to - Correct Answer-transient hypoxemia during uterine contractions. Amnioinfusion - Correct Answer-Amnioinfusion is a method in which isotonic fluid is instilled into the amniotic cavity in order to correct fetal heart rate changes thought to be caused by compression of the umbilical cord [variable decelerations]. Amnioinfusion is used to attempt to resolve variable fetal heart rate decelerations by correcting umbilical cord compression as a result of oligohydramnios. When amnioinfusion is used during labor to treat recurrent severe variable decelerations, it has been proven to reduce the incidence of cesarean deliveries. Amnioinfusion may assist with oligohydramnios (amniotic fluid index <5 cm) Variable Decelerations - Correct Answer-Compression of the umbilical cord, could be caused by oligohydraminos Magnesium and Nifidepine - Correct Answer-Magnesium an anticonvulsant used for pre-eclampsia, substitutes for calcium Nifidepine, CCB, allows the movement of calcium into the smooth muscle of the uterus. Contraction of smooth muscle depends on the availability of calcium Moderate Variability - Correct Answer-The 2008 National Institute of Child Health and Human Development consensus report states that moderate variability reliably predicts the absence of fetal metabolic acidemia at the time it is observed. oligohydramnios - Correct Answer-Oligohydramnios, a decreased amount of amniotic fluid, is defined as a single deepest pocket of <2 cm, or an amniotic fluid index of <5 cm. Normal Transition to Extra Uterine Life - Correct Answer-During normal transition from fetal to extrauterine life, the pulmonary vascular resistance decreases largely in part to air entry into the lung and increase in pulmonary blood flow. Systematic vascular resistance increases with the removal of the placenta. Persistent pulmonary hypertension continues to have the increase in pulmonary vascular resistance with constriction of the pulmonary vessels. This increase in pulmonary resistance can lead to the shunting of blood through fetal channels (ie, ductus arteriosus, foramen ovale). The

shunting of blood from right to left through the fetal shunts further contributes to hypoxemia. Coartication of the aorta - Correct Answer-Coarctation of the aorta has the classic finding of decreased perfusion and pulses in the lower extremities. These infants can develop temperature instability and poor feeding. Congenital heart disease should be suspected when infants present with an increase in respiratory rate in the absence of any other respiratory signs of distress and cyanosis. Gastroschesis care - Correct Answer-At the time of delivery, protection of the intestines is important. The infant should be placed in a sterile bowel bag to allow for visualization of the intestines. In absence of a sterile bowel, another option to protecting the intestines includes covering the intestines with warm sterile saline-soaked gauze that covers the exposed intestines and then applying a plastic covering over the gauze to prevent evaporation and heat loss. Cephelhematoma - Correct Answer-A cephalohematoma is a collection of blood between the periosteum and the skull that does not cross the suture line. It may enlarge during the 24 hours after birth and may take several months to resolve. These infants are at a higher risk for developing hyperbilirubinemia The Kleihauer-Betke test - Correct Answer-identifies fetal cells in the maternal blood. Although the Kelihauer-Betke test can be useful in determining whether the mother needs RhIgG, it will not determine the infant's condition at the time of delivery. High Resolution Ultrasonography - Correct Answer-High-resolution ultrasonography is useful for determining ascites, pericardial and pleural effusion, and other conditions in the baby before delivery. The test gives the resuscitation team the ability to anticipate what degree of resuscitation may be needed. Correct positon of endotracheal tube - Correct Answer-midway between the trachea and carina Chest Compression and Ventilation Resuscitation - Correct Answer-90 Compressions a minute, 1/3 of the diameter 30 breathes a minute Symmetric IUGR - Correct Answer-Symmetrical intrauterine growth restriction (IUGR) begins early in gestation and is most often caused by intrauterine infection or genetic abnormalities. TTN Radiographic findings - Correct Answer-Infants with transient tachypnea of the newborn have chest radiographic findings that include perihilar streaking, overexpansion, haziness, increased vascular markings, and fluid in the fissure, which traps air in the alveoli. This air trapping results in an increase in the anteroposterior diameter of the chest, leaving the infant with a barrel-shaped chest.

Transposition of the great vessels - Correct Answer-Transposition of the great vessels occurs when the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. Marked cyanosis is a presenting feature of transposition because the aorta carries deoxygenated blood from the right ventricle to the systemic circulation. Gastroinsetinal defect associated with down syndrome - Correct Answer-duodenal atresia. Ventral Septal Defect murmur type - Correct Answer-Harsh Holosystolic Murmur heard over Apex patent ductus arteriosus (PDA) location and murmur type - Correct Answer-In healthy term infants the ductus arteriosus normally closes in the first 24 to 48 hours of life. The murmur associated with a patent ductus arteriosus (PDA) is systolic and is best heard over the upper left sternal border and sometimes radiates to the axilla. Shunting of PDA - Correct Answer-In a newborn a patent ductus arteriosus causes right to left shunting resulting in additional blood flow to the aorta. This causes peripheral pulses to feel full and bounding. The Ortolani test is used in assessing for what condition? - Correct Answer-The Ortolani test is used in conjunction with the Barlow test to assess for developmental dysplasia of the hip. Varicella (chicken pox) - Correct Answer-Cicatricial scarring (hair follicles are replaced with scar tissue) is a classic finding in congenital varicella. Limb hypoplasia and microphthalmia (small eyes) are also described with this infection. Erb palsy - Correct Answer-Shoulder dystocia places the infant at increased risk of Erb palsy, an injury to the brachial plexus. With Erb palsy the Moro reflex is asymmetrical and the arm and wrist are positioned in what is referred to as waiter's tip. Laryngomalicia - Correct Answer-Laryngomalacia is the most common cause of stridor in infants and typically presents in the first month of life. Risk factors include prematurity and respiratory support. Omphacele and cardiac defect - Correct Answer-Among infants with omphalocele, 50% have accompanying cardiac defects. Scalded Scar Syndrome - Correct Answer-Scalded skin syndrome is an infection caused by Staphylococcus aureus. Occurring most often in the diaper area or around the umbilicus, it consists of vesicles that may coalesce to form bullae. When the vesicles rupture they leave areas of denuded skin resembling a burn.

Polhydraminos - Correct Answer-The presence of an esophageal atresia in an infant with tracheoesophageal fistula prevents the fetus from swallowing amniotic fluid. Polyhydramnios occurs as a result. Candida Rash - Correct Answer-A candida rash is most often found in the groin and consists of lesions over an erythematous base with satellite lesions extending beyond the groin. Vocal Cord Paryli - Correct Answer-Vocal cord paralysis is a known complication of surgical ligation of the ductus arteriosus. Symptoms of vocal cord paralysis include hoarseness or stridor, choking, and feeding difficulty. Assessing point of maximal intensity - Correct Answer-Because of the dominance of the right ventricle, the point of maximal intensity is best heard over the fifth intercostal space in the immediate newborn period. In addition to hypoglycemia, an infant of a diabetic mother should be assessed for the development of: - Correct Answer-hypocalcemia. Lanugo in preterm infant - Correct Answer-Lanugo covers the entire body beginning at 20 weeks' gestation and does not start disappearing until 28 weeks' gestation. Assessment finding of term infant - Correct Answer-As gestation progresses beyond 38 weeks, the subcutaneous tissue decreases, which causes the skin to wrinkle. At term gestation, the breast tissue nodule measures up to 10 mm. There is cartilage present in the pinna, which allows it to spring back from being folded. Ampicillin 100mg/kg/dose - Correct Answer-Infuse 3-5 minutes followed with flush ELBW, VLBW, LBW weights - Correct Answer-ELBW<100grams VLBW <1500grams LBW <2500grams Potential problems with SGA - Correct Answer-An infant born at 40 weeks' gestation weighing 2000 g is well below the 10th percentile for weight and would be classified as small for gestational age (SGA). Potential problems for which SGA infants are at risk include polycythemia, hypoglycemia, hypothermia, hypoxia, and infection. New Ballard Findings of Term Infant - Correct Answer-In postterm infants, the skin is cracked and wrinkled, plantar creases cover the entire foot sole, and the skin is mostly bald of lanugo. The ears are stiff with thick cartilage. The labia majora cover the labia minora as well as the clitoris. Breast areolae are full with 5- to 10-mm buds. Maintain Blood Glucose Levels - Correct Answer-50-110 mg/dL Volvulus - Correct Answer-Vomiting of bile stained emesis

Make NPO Decompress stomach Abdomen film Upper UGI study Surgical correction to untwist bowel and restore blood flow Placement of UVC - Correct Answer-Tip should be above diaphragm at inferior vena cava/right atrial junction Movement and flexion of extremities - Correct Answer-Generates warmth in muscles Decreases surface area for heat loss Brown fat - Correct Answer-Substance accumulated in increasing amounts as the infant advances through gestation, especially third trimester Brown fat is located around the kidneys, adrenal mediastinum, axillary regions. In response to cold stress, norepinephrine is released into nerve endings in brown fat, causing it to be burned or metabolized. Process is called "non-shivering thermogenesis" Production of heat* Response to cold stress - Correct Answer-Vasoconstriction Prevents blood from reaching skin surface Prolonged vasoconstriction may impair perfusion and tissues Can cause apnea ** Conductive Heat Loss - Correct Answer-Involves transfer of heat between two solid objects. For example, a mattress, scale, x-ray plate. Ways to reduce conductive heat loss place a chemical thermal mattress underneath the infant , clothing and hats, warm blanket on scale. Convective Heat Loss - Correct Answer-Convective heat loss occurs when the infant's body heat is swept away by air currents, such as when the infant is exposed to drafts from air bents, air conditions, windows, doors, heaters, fans, incubator portholes Incubator reduces convective heat loss by providing a warmer environment with an enclosed space Blood Gas Values - Correct Answer-Arterial pH 7.30-7.

PC02 35-

PO2 50-

Bicarbonate 22- Base excess -4 to + Capillary pH 7.30-7. PCO2 35- PO2 35-45 (not useful for assessing oxygenation) Bicarbonate 22- Base Excess -4 to + Evaporative Heat Loss - Correct Answer-Occurs when moisture on the skin surface or respiratory tract mucosa is converted into vapor. Most common forms of insensible losses are from the skin and respiration. Sensible fluid loss are associated with sweating. Ways to reduce evaporative heat loss: quickly dry the infant with pre warmed blanket or towels , polyethylene plastic bags. Humidify respiratory or environmental sources. Polyethylene wrap - Correct Answer-<29 weeks gestation <1500 grams Cover from the neck to the feet Radiant Heat Loss - Correct Answer-Radiant heat loss is the transfer of heat between solid surfaces that are NOT in contact with each other. The infant temperature is usually warmer than the surrounding surfaces. The cooler the surfaces, the greater the heat loss. Cool windows or walls can cause radiant heat loss. Ways to prevent : DOUBLE wall isolates, move infant away from cold windows or walls, Rubella Mnemonic - Correct Answer-Rubber= Rubella Ducky = Patent Ductus Arteriosus, Deafness I'm = Eyes (cataracts, retinopathy, micropthalmia, glaucoma) So = Slow or growth and developmental retardation Blue = Blueberry Muffin" purpura on skin Pulmonary vascular markings (radiology findings) - Correct Answer-Increased - increased heart size, pulmonary edema, heart defects with increased pulmonary blood flow / left outflow tract obstruction Decreased markings - heart lesions with DECREASED pulmonary blood flow (i.e. tet), and PPHN

RDS Radiology findings - Correct Answer-Atelactsis with air bronchograms, under inflated lungs Pneumonia Radiology findings - Correct Answer-Reticulogranular pattern, lack of air bronchograms, over inflation of the lungs O2 challenge test - Correct Answer-For Cardiac Cyanotic CHD PaO2 < 150 Truncus Arteriosis - Correct Answer-1. Single enlarged artery from the left and right ventricular

2. Single Truncal Valve
3. VSD Blood flow pattern in TA - Deoxygenated blood from the right ventricle mixes with oxygenated blood from the left ventricle at the VSD. Blood is ejected through the truncal root to the systemic, pulmonary, and coronary circulation. Truncus arteriosus - Correct Answer-As pulmonary vascular resistance decreases in neonatal period, blood flow to the lungs increases and leads to pulmonary overcirculation and CHF. S/s - tachypnea, bounding pulses, tiring, shortness of breath, diaphoresis Truncus arteriosus radiology findings - Correct Answer-Moderate cardiomegaly Increased vascular markings Truncus arteriosis management - Correct Answer-1. Maine SpO2 between 75-85% to increase pulmonary vascular resistance to decrease excessive pulmonary blood flow.
4. Prostaglandin E1 if interrupted aortic arch
5. Evaluate for 22q11 deletion syndrome (FISH chromosome, immunodeficiency profile, calcium level). Total anomalous pulmonary venous return (TAPVR) - Correct Answer-Abnormal pulmonary venous drainage directly or indirectly to the right atrium. Pulmonary venous returns enters the left atrium through a right-to left shunt across the foramen ovale or ASD. Nagel's Rule for EDD - Correct Answer-add a year, subtracting three months, and adding seven days to the origin of gestational age. 280 days at childbirth.

Hyperkalemia ECG - Correct Answer-Potassium assists in regulating membrane potentials, so any disturbance in potassium can affect the muscle cells of the heart. Hypokalemia causes flattened T waves, whereas hyperkalemia causes peaked T waves and a widened QRS. infant at risk for experiencing hyperthermia? - Correct Answer-Infection increases the infant's body temperature. Because the infant has limited ability to dissipate heat, the infant is at risk of hyperthermia Initial Ventilator Settiongs - Correct Answer-Rate 20-30 for very sick 30-40 for moderaately sick Pip 16- PEEP 4- Calcitonin in perinatal asphyxia - Correct Answer-Perinatal asphyxia and stress will cause an increase in calcitonin. Calcitonin is a counterregulatory hormone that is secreted from C cells of the thyroid gland and functions to decrease calcium levels by inhibiting bone-resorbing osteoclasts. Calcitonin reduces the blood serum concentration Thiazide Diuretic and calcium - Correct Answer-A thiazide diuretic causes calcium absorption and therefore decreases any urinary excretion. Hyponatremia effect on CNS - Correct Answer-Hyponatremia is the electrolyte abnormality that would most likely cause seizure activity (ie, pedaling, sucking, blinking movements). This is because hyponatremia disrupts brain volume, particularly the equal osmolality of extracellular and intracellular fluid. Renal Vasculature in the neonate - Correct Answer-Most healthy premature, full-term, and postterm infants void by 24 hours of life. This is because at birth renal blood flow may not increase initially, but will increase by 24 hours once the renal vascular resistance falls. Macrosomia - Correct Answer-Infants >4000g Colostrum antibody abundance is - Correct Answer-IgA Carnitine - Correct Answer-Carnitine is a carrier molecule needed to transport long- chain fatty acids into mitochondria for oxidation. Minimal Enteral (trophic) feedings with human expressed milk should be initiated at a rate of - Correct Answer-Minimal enteral feedings should be initiated at a rate of 10 to 20 ml/kg/day to facilitate postnatal gastrointestinal maturation and to minimize mucosal atrophy.

Main parental nutritional source for neural tissue / metabolic processes in an infant weighing less than 1000g is - Correct Answer-The main intravenous energy source for neural tissue and metabolic processes is glucose. The rate of glucose production in neonates weighting less than 1000 grams is approximately 8 to 9 mg/kg/min Arachidonic acid and docosahexaenoic acid - Correct Answer-Arachidonic acid and docosahexaenoic acid are considered conditional essential nutrients in preterm infants and should be provided during enteral feedings to improve neurologic and visual development and modulate immune functions. The optimal ratio of calcium to phosphorus to meet recommended dietary daily requirements and enhance growth for the premature infant is: - Correct Answer-2: An early cause of hypocalcemia in the neonate is: - Correct Answer-Infants of diabetic mothers are at risk of developing early hypocalcemia that can persist for several days due to maternal magnesium losses and can lead to fetal magnesium deficiency and secondary functional hypoparathyroidism in the newborn. The severity of the maternal diabetes is associated with the degree of hypocalcemia observed in the neonate. Neurodevelopmental Positioning - Correct Answer-Abnormal head molding, hip adduction and external rotation, and arching posture are prevented by correct neurodevelopmental positioning. First sensory sense for infant is - Correct Answer-Touch is the first sense to develop at approximately 7.5 weeks of age, and sensitivity to touch is very well developed in the face, lips, and hands. Transitional sleep - Correct Answer-Preterm infants do not have significant quiet sleep cycles until approximately 36 weeks' gestation; hence a third sleep state called transitional sleep is identified in preterm infants. Hydrops fetalis -Ascites X ray finding - Correct Answer-Ascites is seen as a centralized bowel gas pattern on x-ray. generalized edema in the fetus secondary to severe anemia resulting from destruction of erythrocytes. Anterior posterior (AP) abdomen and cross-table - Correct Answer-Anterior posterior (AP) abdomen and cross-table lateral films will determine the presence of free air, given the concern for pneumoperitoneum per the clinical examination. Because free air rises, the cross-table lateral has the capability of showing free air positioned just under the abdominal wall.

A 3-cm increase in abdominal girth, visible bowel loops, increased apnea episodes, and a 50% residual from the infant's last feed is noted upon clinical examination. The nurse should anticipate an order for which type of x-ray? Anterior Posterior x-ray - Correct Answer-An A/P chest x-ray will reveal pathology of the lungs, not the abdomen. point of maximal impulse definition and shift - Correct Answer-A tension pneumothorax on the left will shift the mediastinum to the right, moving the point of maximal impulse (PMI) to the right. The point of maximal impulse, known as PMI, is the location at which the cardiac impulse can be best palpated on the chest wall (at apex of heart, left side) Which chest x-ray findings best represent primary surfactant deficiency? - Correct Answer-Hypoexpansion due to atelectasis, air bronchograms from atelectasis of the alveoli interspersed with open airways and a reticulogranular pattern, and open alveoli interspersed with atelectatic alveoli are the classic findings of surfactant deficiency. Which chest x ray findings best represent pneumonia? - Correct Answer-Bilateral streakiness, hyperexpansion, reticulogranular pattern is found with pneumonia Which chest x ray findings best represent a pneumomediastinum? - Correct Answer- Hypoexpansion, sail sign, fluid in the fissure Proper placement of ETT - Correct Answer-Proper placement on an endotracheal tube is midway between the thoracic inlet and the carina. Anticholinergic side effects in neonate - Correct Answer-Anticholinergic drugs block acetylcholine at parasympathetic muscarinic receptors. Their actions include increased heart rate, pupil relaxation, and decreased tone and motility of the gastrointestinal tract. Digoxin MOA - Correct Answer-Inhibition of Na/K/ATPase pumps in the heart, increasing cardiac cell potentials and contractility Meconium ileus - Correct Answer-Inpissated meconium obstructs the terminal ileum just prior to the ileocecal valve. Associated with Cystic Fybrosis (requires pancreatic enzymes to breakdown digest intestinal contents) imperforate anus - Correct Answer-a congenital defect in which the rectal opening is missing or blocked. Imperforate anus in female - Correct Answer-Meconium from a fistula external to the hymen = rectovestibular fistula, most common in females

Imperforate anus in a male - Correct Answer-Most common lesion is the rectoprostatic fistula , distal bowel and urethra Tidal Volume - Correct Answer-Amount of air that moves in and out of the lungs during a normal breath Minute Ventilation - Correct Answer-total volume of air inhaled and exhaled each minute grunting - Correct Answer-Infant's attempt to increase functional residual capacity (lung volume) when there is collapse aveoli. Infant will try to collapse vocal cords to try and trap air in the lungs. Grunting sound is made when the infant exhals through the partial closed vocal cords. Grunting "splint open" small airways and helps to maintain functional residual capacity in the aveoli. Preductal oxygen saturation - Correct Answer-Attach oximeter probe to the right palm at birth. Fetal hyperinsulinemia and lung development - Correct Answer-Fetal hyperinsulinemia contributes to delayed maturation of the lungs, which inhibits the production of surfactant and increases the risk of surfactant deficiency related to respiratory distress syndrome. The reticulograndular pattern is suggestive of respiratory distress syndrome. In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by which of the following? - Correct Answer-The presence of an obstruction to right ventricular (RV) outflow with a large ventral septal defect causes a right-to-left shunt at the ventricular level with arterial desaturation. The greater the obstruction and the lower the systemic vascular resistance, the greater is the right-to-left shunt. Thus the clinical findings vary with the degree of RV outflow obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic. Those with severe obstruction are most likely to be deeply cyanotic from birth. Few children are asymptomatic. In those with significant RV outflow obstruction, many have cyanosis at birth, and nearly all have cyanosis by age 4 months.. Transposition of the great vessels - Correct Answer-In transposition of the great vessels, the degree of cyanosis depends on the amount of mixing between the pulmonary and systemic circulations. Oxygenated pulmonary venous blood is returned to the lungs, and desaturated systemic blood is returned to the body. Thus the two circulations exist in parallel. Some mixing between them must occur to allow oxygenated blood to reach the systemic circulation and the desaturated blood to reach the lungs. balloon septostomy with transposition of the great vessels - Correct Answer-When an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a

technique developed by William Rashkind in 1966, may be performed. The procedure involves inserting a balloon-tipped catheter across the foramen ovale into the left atrium. The balloon is then inflated and forcibly withdrawn so that the catheter tears the septum primum and enlarges the ASD. Mixing should increase immediately, with a corresponding increase in arterial oxygen saturation. CCHD screening - Correct Answer-A screen result would be considered positive if any oxygen saturation measures less than 90%, oxygen saturation is less than 95% in both extremities on three measures—each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation between the right hand and foot on three measures, each separated by 1 hour. Any screening that is >95% in either extremity with no more than a 3% absolute difference in oxygen saturation between the upper and lower extremity would be considered a "pass" result, and screening would end. An infant is born with low-set ears, excess nuchal skin, a broad chest, widely spaced nipples, peripheral lymphedema, and absent pulses in the lower extremities. The nurse suspects the infant has coarctation of the aorta. Which chromosomal defect can cause this constellation of findings? - Correct Answer-Infants with Turner syndrome can present with cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a coarctation of the aorta. VSD at 1 to 2 months of age can result in - Correct Answer-Infants with a small isolated defect are often asymptomatic. The murmur of a small defect may be detected within the first 24 to 36 hours of life, because the very restrictive opening permits the normal rapid fall in pulmonary arterial resistance and pressures. In term infants born at sea level with a large ventral septal defect, clinical deterioration may occur at any time from approximately 3 to 12 weeks after birth. A hyperoxia test PPHN results in - Correct Answer-<100% PaO2. A hyperoxia test RDS vs. cardiac - Correct Answer-A hyperoxia test is performed by administering 100% oxygen for 10 minutes and then measuring the arterial preductal PaO2 (right radial artery). A significant increase in PaO2 levels, particularly a Pa O level >150 mm Hg, makes the likely cause respiratory distress rather than cardiac in origin. Wolff-Parkinson-White syndrome - Correct Answer-episodic supraventricular tachycardia that resolves spontaneously. An echocardiogram is performed, and there is slurred upstroke of the QRS and the presence of a delta wave. Milronone - Correct Answer-Milrinone also provides dose-dependent increase in cardiac contractility and is a systemic and pulmonary vasodilator and thus an effective agent in both right and left ventricular systolic dysfunction.

increasing PIP - Correct Answer-Increase tidal volume , decreases Pco2 Increasing the PEEP without increasing PIP - Correct Answer-May decrease tidal volume and pco2 may rise If pco2 already elevated - Correct Answer-Increasing PIP may be better option Increasing inspiratory time reduces - Correct Answer-Exhalation time and may cause Paco2 to rise A chest radiograph is ordered for an infant with a suspected patent ductus arteriosus. The nurse should anticipate which of the following findings? - Correct Answer-Common clinical manifestations of a patent ductus arteriosus include: -increased pulmonary vasculature and cardiomegaly on chest radiograph -bounding peripheral pulses, and an active precordium. -A widening pulse pressure with a low diastolic blood pressure may be present. Unexplained acidosis may be present. TTN Radiology Findings - Correct Answer--Fluid in the fissures -Perihilar streaking or opacity -lung over inflation / pulmonary edema Pneumonia Radiology Findings - Correct Answer--Diffuse or focal infiltrates -Hazy or opaque lung fields -Lobar Consolidation Meconium Aspiration Syndrome Radiologic Findings - Correct Answer-- Coarse, nodular opacities, atelectasis, over inflation TEF signs and symptoms - Correct Answer-Excessive salivation and choking, coughing, and cyanosis with feeding Congenital Diaphragmatic Hernia - Correct Answer-Abdomen may appear scaphoid (sunken). Decreased breath sounds on side with hernia -Intubate patient -Insert orogastric or nasogastric tube and frequently remove air from the stomach to prevent the air from entering the bowel

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Stridor - Correct Answer-strained, high-pitched sound heard on inspiration (associated with upper airway obstruction) -Expiration (usually associated with lower airway obstruction) Choanal atresia - Correct Answer--One or two nasal passages may be blocked -When both are blocked by a bony septum or soft tissue membrane

-Infant may be cyanotic at rest, will pink up at crying -Insert oral airway, or intubate Pierre Robin - Correct Answer--Small jaw, normal size tongue that obstructs the airway -May have cleft palate -To relieve airway obstruction, turn the infant prone -If airway still obstructed despite positioning prone, insert nasopharngeal tube PPHN - Correct Answer--Affects term infants predominately -Elevated Pulmonary Vascular Resistance causes right-to left shunting of blood passed the PDA or FO which leads to hypoxemia Pneumopericardium - Correct Answer--Air becomes trapped in the pericardial sac that surrounds the heart -Air can accumulate and compress the heart impairing cardiac output -S/s cyanosis, muffled or inaudible heart sounds, Most common type of TEF - Correct Answer-Type C Air can enter the stomach via the tracheal fistula S/s of TEF - Correct Answer-Choking, coughing, cyanosis with feeding, risk of aspiration high can cause pneumonia Excessive salivation *history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic fluid, think TE and bowel obstruction Remember VACTERL Treatment of TEF - Correct Answer--insert feeding tube into stomach, obtain chest xray to determine if there is a pouch -insert orgastric tube into stomach if there is no blind pouch to vent out air -provide low continuous suction to remove secretions -turn infant prone, head of bed elevated 30 degrees to reduce reflux **radiographic studies are CONTRAINDICATED! Congenital Diaphragmatic Hernia - Correct Answer--have a hole in the diaphragm that allows the stomach and bowel to migrate up into the chest most often occur in left chest (pulmonary hypoplasia results) -hypoplastic lungs makes oxygenation and ventilation very difficult -PPHN can present, which is very common with CDH. Polyhydraminos - Correct Answer-history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic fluid, think TE and bowel obstruction

Congenital Diaphragmatic Hernia presentation - Correct Answer-Scaphoid abdomen (sunken) Barrel chest (displaced stomach and bowel filled up with air in the chest) -decreased breath sounds on side with defect Risks associated with Congenital Diaphragmatic Hernia - Correct Answer-- pneumothorax (due to lungs being hypoplastic) -excessive volume or pressure can cause the hypoplastic lungs to collapse -do not over ventilate -dilated bowel and stomach can compress the lung and heart comprising oxygenation, ventilation, and perfusion -right to left shunting can occur secondary to PPHN, check the pre and post saturations What is contraindicated in CDH? - Correct Answer-PPV by mask or BCPAP, will fill the bowel with air and compress lungs and heart. -use minimal ventilation settings (volume) Fetal Circulation Right side of heart - Correct Answer-On right side of heart: -Oxygenated blood drains from brain to the right atrium, then to right ventricle. -Approximately 90% of right ventricular output is ejected into the pulmonary artery and then directly into the ductus ateriosis which connects to the PDA, which connects to the aorta. *This is called right to left shunt (right ventricle --> ductus arteriosis --> aorta). -Roughly 10% of the right ventricular output is ejected into the pulmonary artery and into the lungs. Pulmonary Vascular Resistance in Utero - Correct Answer-The amount of blood entering the pulmonary vasculature is limited because of the high pulmonary vascular resistance during fetal life. **The lungs are not needed for gas exchange nor do they function in utero. Placenta vascular resistance - Correct Answer-Low vascular resistance, readily accepts the return of fetal arterial blood Neonatal Circulation after birth - Correct Answer-After cord cut: -Blood pressure in aorta increases, increasing systemic vascular resistance -Blood pressure in lung decreases, decreasing pulmonary vascular resistance. More blood enters lungs and fills left atrium. The increased pressure in the left atrium helps to functionally close the right to left shunt through the foramen ovale. Physiology of PPHN - Correct Answer-Vasoconstriction related to acidemia, hpoxemia, hypothermia, and sepsis Blood shunts away from the lungs through the ductus arteriosis and or foramen ovale.

1. Pulmonary blood vessels constrict
2. increases resistant to blood flow into the lungs
3. blood flows via pathway of least resistance
4. Right ventricle to pulmonary artery
5. Pulmonary arteryy to ductus arteriosis and aorta
6. Deoxygenated blood enters arterial circulation
7. Hypoxemia
8. Perpetuates pulmonary vascular resistance and right to left shunting Vasospasm delayed relaxation causes arterioles to constrict cardiac tamponade - Correct Answer-filling of the pericardial sac with blood and possibly fluid, thus causing a decline in cardiac function. Symptoms may include a period of initial tachycardia followed by bradycardia, pulse paradoxus, PR depression, ST elevation, electrical alternans, declining or absent pulses, and quiet or absent heart sounds. Blood pressure first week of life - Correct Answer-Normal blood pressure for the first week of life is considered to be a mean arterial blood pressure at least equal to the gestational age of the infant. This infant is hypotensive given the gestational age of 24 weeks and the mean arterial pressure of 23 mm Hg. Low BP = hypotensive Most important ductal dependent intervention - Correct Answer-The single most important intervention for a ductal-dependent lesion is the infusion of IV prostaglandin E1 (PGE1) to ensure ductal patency and improve left-to-right shunting and systemic blood flow. The initial dose of PGE1 is usually 0.1 mcg/kg/min. PGE1 should then be titrated to the lowest effective dose and can be administered through an umbilical venous catheter, central line, IO line, or peripheral IV line with equal efficacy, although central access is preferred. Which of the following cardiac lesions can be palliated with a transcatheter balloon valvuloplasty? - Correct Answer-Aortic Stenosis A balloon valvuloplasty can be performed in the catheterization laboratory immediately after the infant has been stabilized with medical and pharmacologic treatment, including prostaglandin E1. Intermittent Cyanosis after birth a sign of - Correct Answer-The anatomy of truncus arteriosus involves a single great artery originating from both the left and right ventricles. The blood flow to the lungs is directly dependent on the pulmonary vascular resistance. As the pulmonary vascularity changes, the pulmonary blood flow will also change, causing changes in the amount of blood flowing into the lungs.

Blood pressure gradient Coart of Aorta - Correct Answer-The BP (>15 mm Hg) is the most consistent factor in critical coarctation of the aorta and is present in 97% of cases. Sodium Bicarb - Correct Answer-Hypertonic solution if given too rapidly may lead to IVH. Infant must be ventilated if given bicarb due to the an acute increase in CO2 as the bicarbonate is metabolized. caput succedaneum - Correct Answer-serosanguineous fluid under subcutaneous tissue of the fetal scalp that crosses the suture lines. reabsorbes within 24-72 hours Cephalahematoma - Correct Answer-collection of blood between a skull bone and its periosteum Resolves in 2 weeks to 3 months Subgleal Hemmorrhage - Correct Answer-Subgleal space holds 240mL of blood potentially the entire blood volume Feels boggy Crosses suture lines Can lead to severe anemia and hypovolumec shock HSV risk factors , signs and symptoms, testing - Correct Answer-HSV type 1 and 2 may be present in maternal genital tract without MOB knowledge Severe HSV infection is more likely if the mother contracted a primary (first episode) HSV infection in late gestation Infants may be asymomptomatic for 3-14 days Signs and symptoms include skin VESICLES, Obtain culture or PCR testing. Start Acyclovir If MOB has active genital or buttock lesions start acyclovir to infant. Prostaglandin E1 is a potent - Correct Answer-Vasodilator may cause hypotension, hyperthermia, apnea. Reverse differential cyanosis - Correct Answer-he infant has reversed differential cyanosis. This can be seen with transposition of the great arteries when the preductal saturations are lower than the postductal saturations. The transposition of the arteries leads to two separate circulations. The deoxygenated blood goes out the right atrium to the aorta to the body (right hand); therefore the pulse oximeter reading is lower. Milronone mechanism of action and monitoring - Correct Answer-Milrinone is phosphodiesterase inhibitor that increases heart rate and contractility and is a