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

What risks are present in infants born to mothers who receive no or little prenatal care?

• Correct Answer-LBW premature birth Maternal iron-deficiency anemia Increased neonatal mortality Describe the fetal response to mothers with diabetes - Correct Answer-Because glucose crosses the placenta, the baby's BG increases as the mom's does. Insulin does not cross the placenta and the fetal pancreas does not produce it until 20 weeks. So, before insulin production, the increased BG leads to restricted growth. Once the insulin is produced, it produces rapidly to respond to the high BG, and these high levels trigger rapid fetal growth—> hepatosplenomegaly, cardiomegaly, increased head size What is commonly seen in IDM immediately after birth? Why? - Correct Answer- Hypoglycemia The sudden withdrawal from maternal glucose + continued production of insulin What conditions does an IDM present with? - Correct Answer-Birth trauma r/t cephalopelvic disproportion Hypoglycemia RDS because inc insulin inhibits surfactant production Polycythemia & hyperviscosity bc inc insulin & BG inc metabolic rate and oxygen consumption Iron deficiency bc polycythemia leaches iron Hyperbilirubinemia from inc rbc destruction CV & congenital malformations Electrolyte disturbances (low Ca and Mg) What is pre-eclampsia? - Correct Answer-Inc BP, proteinuria, edema that occurs around 20 week's gestation What's the initial tx for pre-eclampsia? - Correct Answer-Mag sulfate to prevent maternal sz If severe—premature delivery What complications occur to fetus with a mother suffering from pre-eclampsia? Why? - Correct Answer-IUGR— longstanding HTN causes uteroplacental vascular insufficiency which impairs transfer of nutrients and oxygen which causes IUGR and inc mortality What is the purpose of amniotic fluid and how is it produced? When? - Correct Answer- To cushion fetus and allow normal development of lungs

Produced mainly by fetus' excretion of urine and fluids excreted by respiratory tract & oral/nasal cavity Around 20 week's What is oligohydramnios? What conditions are associated with it? - Correct Answer- Decreased AF UT anomalies like obstructive uropathy, renal agenesis, polycystic kidneys Pulmonary hypoplasia Pressure deformities Compression of umbilical cord & hypoxia Mecon staining (remember hypoxia causes release of mecon in utero) Post-term gestation Leaking AF, prolonged or premature ROM What is polyhydramnios & what is it associated with? - Correct Answer-Increased AF TEF, EA, duodenal atresia Anencephaly CNS abnormalities that impair swallow Twin-twin transfusion Macrosomia Fetal/neonatal hydrops & assoc CV rhythms Trisomy 21, 18, 13 Skeletal malformations Inc risk for prolapsed cord/placental abruption What is the biochemical marker useful in predicting preterm birth? - Correct Answer- Fibronectins What is the best indicator of fetal oxygenation status during labor as seen on electric fetal monitoring? - Correct Answer-Variability What are the five parts of the biophysical profile? - Correct Answer-Fetal tone, breathing, movement; no stress test, amniotic fluid volume When should one have a glucose screening during pregnancy if they're at low risk for developing GD? - Correct Answer-24-28 weeks When women give birth sitting upright, what shows lower values in cord blood? - Correct Answer-PCO An intrauterine pressure catheter, placed for monitoring of uterine pressure, amino infusion, and fluid sampling, is useful in the treatment of what? - Correct Answer- Variable decelerations by correcting cord compression What is the normal blood volume for a neonate? - Correct Answer-85-100 mL/kg

What are some risks for fetal maternal hemorrhage? - Correct Answer-Maternal trauma Placental abruption Placental tumors Third semester amnios Fetal hydrops Twins What test is used to determine if FMH has taken place? - Correct Answer-Kleihauer- Betke test examines maternal blood for fetal hemoglobin; determines the amount of hemorrhage that has taken place What increases the chances of having multiple births? - Correct Answer-Delayed childbearing What are risks of multiple gestations? - Correct Answer-Premature birth LBW Morbidities such as CP What effects does smoking during pregnancy have? - Correct Answer-Carbon monoxide, nicotine, and hydrogen cyanide cross placenta—CO displaces oxygen from hemoglobin so fetus has decreased O2 delivery SGA Congenital birth defects Placenta previa/abruption What risks are present when a mom continues smoking post partum? - Correct Answer- SIDS increased infant resp infections Asthma Behavioral problems If mom has history of CHD, what risks does baby have? - Correct Answer-Miscarriage C section Prematurity SGA Congenital heart disease Maternal alcohol use can lead to... - Correct Answer-Spontaneous abortion Placental abruption Amnionitis Premature birth FAS

What characteristics are common with FAS? - Correct Answer-Craniofacial abnormalities CNS abnormalities (microcephalic, ID, delays, ADD) Skeletal abnormalities (contracture, scoliosis) Congenital abnormalities (cleft palates, heart defect) SGA and growth deficiency What risks are present with maternal age over 35? - Correct Answer-Chromosomal abnormalities Pre-eclampsia Placenta previa Increased incidence of gestational diabetes Premature birth Still birth Twins Adolescent pregnancies have what associated risks? - Correct Answer-Cephalopelvic disproportion & c section Maternal death Pre eclampsia Placenta previa LBW IUGR because moms growth competes with fetal nutrition Premature birth What is placenta previa? - Correct Answer-Implantation of placenta over or near cervical os What risks accompany placenta previa? - Correct Answer-Hemorrhage in third trimester Poor growth Congenital anomalies Premature birth What is placental abruption? Risks? - Correct Answer-Detachment of placenta from uterine wall prematurely; partial or total Partial leads to IUGR Severe bleeding with total detachment—premature or death What factors contribute to insensible water loss? - Correct Answer-Prematurity Radiant warmers Phototherapy Fever Low humidity Tachypnea

What s/s accompany hypernatremia? Complications? - Correct Answer-Lethargy Hyperreflexia Spasticity Seizures Venous sinus thrombosis Seizures IVH What is the total body water content for a premature infant? Term? - Correct Answer- Premature 90% Term 75% Physiologic diuresis occurs & term loses 5-10% of weight and preterm loses 10-15% of weight When is SIADH common & what is it? - Correct Answer-With birth asphyxiated infants Secrete excess ADH which causes kidneys to decrease UOP S/S of SIADH - Correct Answer-Hyponatremia (sz, twitching, irritability, apnea) Dilute serum Excessive Na in urine Elevated osmolality What does an EKG look like with hyperkalemia? - Correct Answer-Peaked T waves and widened QRS What is hypocalcemia and how does it present? Late onset? Treatment? - Correct Answer-<4. Presents with jitters, irritability, stridor, tetany, high pitched cry, seizures, decreased myocardial contractility Late onset is after first WOL and is typically caused by digeorge syndrome, hyperphosphatemia, low vitamin D, hypoparathyroidism, mg deficiency, diuretic therapy Treat with slow Ca infusion What is hypermagnesemia? S/S and cause? - Correct Answer-Mg > 2. Hypotonia, hyporeflexia, apnea, low BP, constipstion Commonly caused by maternal administration prior to delivery (aka for pre eclampsia) What is the normal glucose requirement in neonates? - Correct Answer-4-8 mg/kg/min

Use 4 for preterm, 8 for term as preteens have lower tolerance Normal fluid requirement - Correct Answer-100-150 mL/kg/day What happens to the K level shortly after birth? - Correct Answer-Rises within 24- hrs, especially in preterm; falls to normal Hypokalemia causes, symptoms, and tx - Correct Answer-Chronic diuretic use and excessive nasogastric drainage Cardiac arrhythmias, ileus, lethargy Slow k administration oral or IV What are the caloric needs for a newborn? Preterm? When will that change? - Correct Answer-Full term 100-120 cal/kg/day Preterm 110-160 cal/kg/day Those recovering from surgery or with chronic illness may need up to 160- How many calories do most formulas & breast milk contain? - Correct Answer-20 cal per oz How many ounces does an infant need to ingest the right amount of calories? - Correct Answer-6 oz/kg/day to reach 120 cal/kg/day What are the protein requirements for a preterm infant? Full term infant? How to reach them? - Correct Answer-Preterm 3-3.5 g/kg/day Term 1.8-2.2 g/kg/day Parenteral nutrition with protein, special formulas, breast milk fortifiers How many calories does an infant on TPN need? - Correct Answer-Preemie needs at least 100-110 cal/kg/day Main calorie component of TPN and amount needed? - Correct Answer-Dextrose Start at 6 mg/kg/min and increase to 10-12 mg/kg/min over a few days Use of lipids and amount - Correct Answer-For the absorption of fat soluble vitamins A, D, & E Start at 1 gm/kg/day and increase to 3 gm/kg/day What are some diagnostic tests for NEC? - Correct Answer-Platelet less than 100, Low or high WBC acidosis Abnormal abx and chest X-ray

What is lactase and what role does it play in diagnosing NEC? - Correct Answer-The enzyme required to metabolize lactose carbohydrates A positive test for reducing substances in the stool of premature infant indicates malabsorption of carbs and may be early sign of NEC What is the purpose of trophic feedings? - Correct Answer-Prevent atrophy of gut and enhance GI maturation and small intestine motility May protect preemies from NEC What are the fluids of choice for trophic feedings and how much should be given? - Correct Answer-Colostrum, human breast milk, preterm infant formula 1-2 mL/kg per feeding no more than 15 mL/kg/day How do preterm formulas differ from term formulas and breast milk? - Correct Answer- 24 cal/oz instead of 20 Increased protein, vitamins and minerals (esp vitamin D, calcium and phosphorous to prevent osteopenia) Less lactose (preemies short on lactase) What are the main sources of calories in infant formulas and how much do they provide? - Correct Answer-Carbs-1 gram is 3.4 calories; makes up 1/3 of caloric content Lipids- 1 gram is 9 calories; makes up 2/ Protein- 1 gram is 4 calories; less than 5% of caloric content in formulas —provides amino acids used as building blocks for muscle and other tissue What is osteopenia of prematurity? How is it diagnosed? - Correct Answer-Decreased bone mineralization Craniotabes, impaired linear growth, thickening of wrists and ankles, elevated alkaline phosphatase in blood serum What are the risk factors for OOP? - Correct Answer-Prematurity (<34 weeks) bc last trimester large amounts of Ca and P are provided to fetus Weight < 1500 g Delayed onset of enteral feeds Chronic use of steroids or diuretics by mother or infant Feeding full term formulas to preterm infants Role of vitamin A - Correct Answer-Growth & development of tissues, functioning of immune system Reduces incidence of BPD Role of Vitamin D - Correct Answer-Adequate Ca and P absorption to decrease risk of rickets

Role of vitamin E - Correct Answer-Limited in preterm infant making them susceptible to developing hemolytic anemia Role of Vitamin K - Correct Answer-Clotting process given shortly after birth to prevent hemorrhagic disease of the newborn Carnitine and the preterm infant - Correct Answer-Present in human breast milk and formulas but premature infants have low tissue stores so may need supplementation so they're better able to metabolize fats Symptoms of carnitine deficiency - Correct Answer-Increased episodes of apnea Decreased muscle tone Poor growth When must a soy formula be used? - Correct Answer-Galactosemia and hereditary lactose deficiency When can soy formula not be used? Why? - Correct Answer-In preterm infants < 1800 g bc it results in less weight gain, increases risk of osteopenia, elevated ALP & aluminum What are three types of specialized formulas? - Correct Answer-Pregestimil Sim PM 60/ Nutramigen LIPL What is pregestimil and when is it used? - Correct Answer-A hypoallergenic formula that provides predigested protein For infants with malabsorption caused for GI or hepatobiliary disease What is sim PM 60/40 and when is it used? Why is it called 60/40? - Correct Answer- Cows milk based formula with low P content and low renal solute load For those with impaired renal function o hypocalcemia due to high P Whey to casein ratio of 60: What is nutramigen LIPL and when is it used? - Correct Answer-Hypoallergenic formula with hydrolysis (digested) proteins that are easier to absorb Used for infants sensitive to the intact protein found in cows milk based formula Used when there is a cows milk protein allergy What is the IV lipid protocol? Possible complications? - Correct Answer-Start with 0. g/kg on third DOL & advance slowly to final admin rate of 3-3.5 g/kg/day by 7-10 days Kernicterus in those with elevated unconjugated bili Exacerbation of chronic lung dz & persistent pulm HTN

Protocol for iron supplementation in neonates - Correct Answer-Preterm infants susceptible to iron deficiency due to lack of maternal iron transfer during third trimester Premature infants fed human milk should have supplemental iron once they reach full feeds or iron fortified formulas What is extrauterine growth restriction? What is it associated with? - Correct Answer- Poor growth after birth common in premature infants (especially VLBW) Short stature Adverse neurological outcomes like neurosensory impairments, delayed development & poor school performances What are some causes of respiratory acidosis? - Correct Answer-Processes that disturb the transfer of CO2 across the respiratory membrane eg inflammation or excessive fluid Decreased respiratory rate Severe pulmonary disease Muscle fatigue Central depression of breathing What vent changes should be made to treat respiratory acidosis? - Correct Answer- Increase tidal volume by increasing PIP, PEEP or rate What are some causes of metabolic acidosis? - Correct Answer-Lactic acidosis production from inadequate tissue perfusion and oxygenation Hypothermia —> increased lactic acid production Renal failure Excessive chloride in IVF diarrhea When does late metabolic acidosis of prematurity occur? - Correct Answer-In premature infants who receive high protein or amino acid feedings bc the immature kidneys cannot excrete the acids How do you screen for late metabolic acidosis of prematurity? - Correct Answer-Check urine pH, if it's less than 5.4 then it indicates kidneys are maximizing their ability to excrete acid Low blood pH, low pCO2 ( compensating), low bicarb What complications arise from late metabolic acidosis of prematurity? How is it treated?

• Correct Answer-Less weight gain and increased excretion of Na Give alkali or NaCl to lessen acidosis

How does the neonates body respond to metabolic acidosis? - Correct Answer-The respiratory center is stimulated to increased RR & decrease serum CO2 to increase the pH The kidneys secrete increased amounts of H in the urine to conserve bicarb How do you compare a venous blood gas and an arterial blood gas? - Correct Answer- Add .05 to the pH of the VBG subtract 5-10 from the PCO2 of the VBG Anions - Correct Answer-negatively charged ions K & Na Cations - Correct Answer-positively charged ions Cl & bicarb What is base excess? Normal range? - Correct Answer-The amount of base needed to return pH to normal -2 to 2 Negative is acidosis, positive is alkalosis What is the anion gap formula? Normal? - Correct Answer-(Na + K) - (Cl + HCO3) 8- What does an enlarged Anion gap indicate? - Correct Answer-Metabolic acidosis is > 30 DKA What can cause a low anion gap? - Correct Answer-Lactic acidosis from sepsis Multiple myeloma Low Na Low albumin High Mg What is the oxygen hemoglobin dissociation curve? - Correct Answer-A graph that plots the % of hbg that is saturated with O2 on the y and different partial pressures of O2 on the x It represents how strongly the hgb is binding to the O What does a shift to the R on the O2 hgb curve mean? Shift to L? - Correct Answer-Hgb has less affinity for oxygen (greater amounts of O2 are released) Increased affinity of hgb to oxygen Fetal hgb vs adult - Correct Answer-Greater affinity for oxygen than adult so aids in transfer of oxygen from maternal blood to fetal blood in placenta What is permissive hypercapnia and why do we do it? - Correct Answer-Those receiving assisted ventilators support are allowed to have slightly higher CO2 levels

To increase resp drive, shorter duration of vent, decreased lung trauma from less aggressive settings What is a potential harm associated with permissive hypercapnia? - Correct Answer- Increased cerebral blood flow —> increased risk of IVH Why does lactic acidosis occur? Effects? - Correct Answer-Secondary to tissue hypoperfusion from hypoxia, sepsis... decreases cardiac contractility and worsens tissue perfusion Treatments of lactic acidosis - Correct Answer-Sodium bicarb and tromethamine (THAM) Risks associated with bicarb tx for acidosis - Correct Answer-Decreased K & Ca Increased Na Increased PCO Risks associated with THAM tx for acidosis? Positive? - Correct Answer-High K Low BG Hepatic necrosis Should raise pH without producing excess CO What is a neutral thermal environment? - Correct Answer-Environmental temp at which the baby must expend the least energy to maintain its proper temperature ie where oxygen consumption and caloric utilization are lowest What are the types of heat transfer in neonates? - Correct Answer-Radiation-not in contact, eg by a window Convection-transfer of heat to the air around and across infants body eg isolette Conduction-in contact, eg cold scale Evaporation-moisture evaporates eg when wet What is non-shivering thermogenesis? How does it occur? - Correct Answer-The oxidation of brown fat to create heat Posterior hypothalamus responds to cold temp by triggering adrenal glands to release norepi & pituitary gland to release thyroxine which stimulate NST When does brown adipose production begin? - Correct Answer-Around 26-28 week's gestation, continues to 3-5 weeks post delivery What can rapid rewarming cause? - Correct Answer-Apnea or hypotension Why are premature infants more susceptible to hypothermia? Ways to prevent? - Correct Answer-Decreased SQ fat and brown fat

Immature skin that isn't keratinized so more permeable to evaporative loss -less permeable after 7-10 days of life Humidified incubator What is digoxin used for and how does it work? - Correct Answer-Heart failure and cardiac arrhythmias Slows and strengthens heartbeat by... Direct action on myocardium by inhibiting action of Na/K pump which increases intracellular Na & Ca and extracellular K which increases strength of contractions Indirect action through autonomic nervous system decreasing electrical conduction through the AV node Why is digoxin considered dangerous? What are signs of toxicity? - Correct Answer- Has a narrow therapeutic index-aka lethal dose is close to therapeutic dose GI-anorexia, N/V/D Cardiac dysrhythmias What are the effects of low dose epinephrine? - Correct Answer-Positive inotropic— heart muscle contracts more strongly Chronotropic—increases HR and vasoconstriction of blood vessels that supply skin & kidneyw What are the effects of high dose epi? - Correct Answer-Vasoconstriction in lungs, viscera, skeletal muscles, brain, and coronary vascular beds What can an OD of epi cause? - Correct Answer-Myocardial irritability Dysrhythmias Hyperglycemia Hypokalemia What is epinephrine? - Correct Answer-A sympathomimetic that triggers alpha and beta receptors in heart and blood vessels What are beta blockers? What do they do? - Correct Answer-Block beta 1 & beta 2 receptors locates on the heart, blood vessels, lungs and kidney Prevent epi and norepi from attaching and having any effect Heart has beta 1 and blood vessels have beta 2 What is an example of a beta blocker? What does it do? When is it used? SE? OD? - Correct Answer-Propanol non-cardioselective (affects heart and other)

Decreases HR and force of contraction Peripheral vasoconstriction —> cool extremities Treats essential and renal HTN Angina Tachyarrhythmias MI Side effects CHF & bronchospasm OD causes arrhythmias, SOB, dizziness, weakness, seizures What is first pass metabolism? How to avoid? - Correct Answer-What occurs to ingested drugs that are absorbed through GI tract and enter hepatic portal system Drugs metabolized in the first pass travel to liver where they are broken down, some to the extent that only a small fraction of the active drug circulated to rest of body —reduces bioavailability of some drugs IV, IM, sublingual What are the three types of diuretics and how do they work? - Correct Answer-Loop (eg lasix) - most potent, work on loop of Henle Thiazide (eg diuril) inhibits Na/Cl transport Potassium sparing (eg aldactone) inhibit aldosterone which promotes K secretion and Na reabsorption What is the duration and half life of fentanyl? Dose? Side effects? - Correct Answer- Duration 1-2 hrs, half life 2- 1-4 mcg/kg ever 1-2 hrs Respiratory depression Peripheral vasodilation Inhibits intestinal peristalsis Chest wall rigidity Less likely to cause hypotension than morphine What is the duration and half life of morphine? Dosage? When is it used? Side effects?

• Correct Answer-Duration 3-4 hrs, half life 2-4 hrs 0.02-0.1 mg/kg every 1-4 hrs Used post op Respiratory depression Histamine release

Seizures What are prostaglandins used for? SEs? - Correct Answer-To maintain PDA in those with congenital heart defects dependent on ductus until surgery Apnea Fever Flushing Low BG What are the symptoms of a PDA and how is it treated? - Correct Answer-Heart murmurs, wide pulse pressure, prolonged cap refill, apnea or RDS Cxray shows increased vascular markings from increased pulm blood flow Indomethacin or surgical What is indomethacin and how does it work? - Correct Answer-A NSAID that treats PDA by inhibiting the production of prostaglandins (esp PGE) Side effects and contraindications of indomethacin? - Correct Answer-Decreased blood flow to brain, kidneys, GI tract Prolonged bleeding for 48 hours after last dose Contraindicated in renal failure, GI bleeding, thrombocytopenia, and NEC When is gentamicin used? What toxicities are associated? - Correct Answer-For gram negative bacterial infections like staphylococci Ototoxicity & nephrotoxicity Renal patients may need dosing every few days When are gent peaks drawn? Troughs? - Correct Answer-Peak 30 min after infusion completes Trough 30 minutes prior to next dose How is apnea of prematurity treated? Why not the other med? - Correct Answer-With caffeine (10 mg oral)—replaces aminophylline because it has a wider therapeutic index & a slower excretion rate Side effects of caffeine? Toxic effects and how to treat? - Correct Answer-Irritability Tachypnea Vomiting Fever Hyperglycemia

Seizures-diazepam or phenobarb What is important to know about plasma proteins? Example of highly protein bound meds? - Correct Answer-They can displace bilirubin from binding sites which increases risk for kernicterus Indomethacin and phenobarb Routes of medication administration - Correct Answer-Oral-subject to first pass metabolism by liver IV-100% absorption IM-fairly quickly absorbed SQ-slow absorption because dermis is less vascularized than muscle What happens if you make a drug addicted baby quit cold turkey? - Correct Answer- Heart attack Vomit aspiration Pulmonary edema Side effects of opiate weaning - Correct Answer-Respiratory depression Sedation Constipation What is enterohepatic circulation? What drug undergoes this? - Correct Answer-When portions of the drug are secreted in the bile and reabsorbed by intestinal tract which reduces the clearance of the drugs and increases the duration of action Only the portion not reabsorbed is secreted in the stool Indomethacin What to take into account when giving medications to kids with poor renal function? - Correct Answer-If the meds are excreted unchanged by kidneys (eg gentamicin) use extreme caution Some meds are metabolized by liver and then excreted by kidneys or excreted in bile What can fetal exposure to nicotine cause? What about chronic exposure? - Correct Answer-Miscarriage, perinatal death, NICU admissions, SIDS, learning disabilities Nicotine withdrawal—irritability and tremors within 12-24 hours and gone by 48 hours When does the ability to coordinate suck & swallow occur? - Correct Answer-32- weeks gestation

What are some benefits of non-nutritive sucking? - Correct Answer-Improved digestion of enteral feeds because digestive enzyme release is stimulated Facilitated development of coordinated nutritive sucking behavior Calming of distressed infant What benefits accompany prone positioning? - Correct Answer-Stabilization of chest wall Improved ventilation Increased time in quiet sleep What are the levels of consciousness when neonates are awake and which is most productive? - Correct Answer-Drowsy, crying, active alert, quiet alert Quiet alert is period of intense learning and international—more positive for infant & caregiver Active alert has variable responses to outside stimuli What are the types of sleep? - Correct Answer-Quiet and active Quiet-restorative and fosters anabolic growth, increased cell mitosis and replication, lowered oxygen consumption, release of GH Active-processing and storing info, REM, moves frequently and breathes irregularly What is coarctation of the aorta? How often does it occur? - Correct Answer-Narrowing of the aorta distal to where the major vessels supply blood to the upper body & head, restricting blood flow to lower body 6-8% of infants When do symptoms of coarctation of the aorta occur? What are they? - Correct Answer- When the DA closes Tachypnea, tachycardia, increases WOB, poor or absent pulses in legs, murmur What is the ductus arteriosus? When does it close and why? - Correct Answer- Connection between pulmonary artery and aorta that shunts blood around non functioning lungs of fetus Usually closes within first 24 hrs after birth due to pressure changes What is the ductus venous? When does it close? - Correct Answer-Connection between umbilical vein and inferior vena cava, carries oxygenated blood from placenta past the fetal liver to the fetal brain Closes within first week of life

What is the foremen ovale? Why does it close? - Correct Answer-Connection between right and left atrium that allows blood to flow from the right atrium into the left atrium Oxygenated blood is shunted away from non functioning fetal lungs Elevated pressure in L atrium after birth causes flap to close How does left heart failure present and why? - Correct Answer-When the left ventricle doesn't pump efficiently, fluid accumulates in lungs —> symptoms of RDS like tachypnea, refractions, grunting, & difficulty feeding How does right heart failure present and why? - Correct Answer-Enlarged liver, spleen, ascites and edema because blood is backing up in systemic circulation How is heart failure treated? - Correct Answer-Digoxin is used to make heart contract harder Diuretics to reduce intravascular volume which decreases preload and allows heart to pump more efficiently What is shock and what are the three types? - Correct Answer-When the CV system is unable to supply organs with adequate perfusion Hypovolemic Distributive Cardiogenic hypovolemic shock - Correct Answer-Inadequate intravascular blood volume due to blood loss from placental abruption or excessive fluid loss from gastro or omphalocele So insufficient fluid is available to fill heart and perfume tissues efficiently Distributive shock - Correct Answer-Aka septic shock—type of hypovolemic shock where capillaries are excessively permeable and fluid moves from intravascular space to extracellular spaces Accompanied by vasodilation which further exacerbated decreased intravascular volume Cardiogenic shock - Correct Answer-When cardiac muscle doesn't pump with enough strength to maintain tissue perfusion Caused by myocarditis, hypoxemia, hypoglycemia, acidosis, or dysrhythmias

How does a neonate compensate for the inadequate perfusion that accompanies shock? - Correct Answer-Vasoconstriction of vessels supply skin, skeletal muscle and GI—cools skin and causes increased cap refill Tachycardia Decreased urine output What does uncompensated shock look like? - Correct Answer-Decreased consciousness Renal failure Acidosis from anaerobic metabolism due to hypoxemia & resp failure Hypotension as heart muscle fails in late shock What is PDA and what does it cause? - Correct Answer-When the ductus arteriosus doesn't close after birth Reversed fetal flow causes increased amounts of blood to circulate through lungs —> pulmonary edema and resp distress How does PDA present? - Correct Answer-Untreated leads to increased WOB, poor weight gain, hepatomegaly Murmur-loudest over L second ICS Bounding peripheral pulses = wide pulse pressure Cxray may indicate pulmonary congestion Echo is definitive diagnosis How is PDA treated? - Correct Answer-Indomethacin or surgery What are the surgical corrections for PDA? Contraindications? - Correct Answer- Percutaneous cardiac cath—preferred, 95% success rate; places coil closure device within ductus that promotes clot formation and occludes ductus ((contraindicated in those with large PDAs or preemies with vessels too small for catheterization)) Surgical ligation—thoracotomy & isolation of ductus; May stitch both ends & cut through middle which closes it or use a thorascope for a muscle sparing thoracostomy What are cyanotic heart defects and which ones are they? - Correct Answer-Those that mix deoxygenated blood with oxygenated blood (R—>L) after blood passes through the lungs 5Ts: tetralogy of fallot, transposition of great vessels, truncus arteriosus, total anomalous pulmonary venous return, tricuspid atresia What are acyanotic heart defects? - Correct Answer-May restrict flow or mix deoxygenated blood with oxygenated blood (L—>R) prior to passing through lungs

Cyanosis doesn't occur but increased pulmonary blood flow causes pulmonary congestion Coarc, valve stenosis, PDA, septal defects What is a ventral septal defect? How do they present? How are they treated? - Correct Answer-Most common acyanotic heart defect where blood from from higher pressured L ventricle blows to lower pressure R ventricle (L—>R shunt) Small ones may have a murmur because they have more turbulent blood flow, but are left untreated and usually close on their own Large ones can lead to pulmonary congestion and typically require surgery; no murmur What is pulmonary stenosis? What does it cause? - Correct Answer-An acyanotic and obstructive congenital defect (may accompany a VSD) typically found in pulmonary valve due to it not being fully open Right ventricle has increased pressure due to obstructed outflow & enlarges over time —> R ventricular hypertrophy Older kids may become fatigued on exertion What is SVT, what is it associated with, and how is it treated? - Correct Answer-HR

240 unaffected by activity or rest Wolff-Parkinson-White syndrome, drug withdrawal, adverse reaction, congenital heart problems, hyperthyroidism, post cardiac surgery Treated with IV adenosine, cardioversion, ice or knees to chest What is atrial flutter, what is it associated with, and how is it treated? - Correct Answer- Atrial rate of 250-400; saw tooth flutters on EKG Congenital heart disease, WPW syndrome, rheumatic mitral disease, hyperthyroidism, drug withdrawal or adverse reaction, post heart surgery Stable treated with digoxin then procainamide which converts flutter to normal sinus; unstable cardioverted What is the SA node? How does it work? - Correct Answer-The intrinsic pacemaker— originates each heart beat Goes through the walls of both atria—>contraction then goes to AV nose & AV bundle to the purkinjie fibers which leads to ventricular contraction

What are the four components to TOF? - Correct Answer-Large VSD —R—>L shunt causes deoxygenated blood to mix with oxygenated which leads to cyanosis Pulmonary stenosis—>increased shunting Overriding aorta Right ventricular hypertrophy from PS Symptoms of TOF? - Correct Answer-Cyanosis that worsens with crying Dyspnea Hypotonia Decreased levels of consciousness Tet spells (w/ feeding or BW) Systolic murmur Treatment of TOF? - Correct Answer-Lessen R—>L shunt by increasing systemic vascular resistance and decreasing pulmonary vascular resistance More oxygen Morphine to relax pulmonary arteries Vasoconstrictors to increase SVR Beta blockers to relax R ventricle and decreases pulmonary vascular resistance IVF to increase SVR Knees to chest to increase SVR What is the diving reflex and how does it work? - Correct Answer-Ice to face to slow HR Vagal maneuver to increase parasympathetic system and slow HR What is air leak syndrome? - Correct Answer-When an alveolus ruptures and air leaks into a space that it normally doesn't occupy aka pneumo & tension pneumo, etc What are the types of apnea of prematurity? - Correct Answer-Centrally mediated- related to immaturity of respiratory center in the brain Obstructive apnea-occurs with collapse of upper airway What is respiratory distress syndrome caused by? How is it treated? - Correct Answer- The absence or deficiency of surfactant, which causes lungs to be more compliant and keeps the alveoli from collapsing on end expiration. Levels are inadequate until 36 weeks gestation Surfactant given to any infant requiring intubation. Typical recovery phase associated with natural diuresis of excess fluid What is PPHN? - Correct Answer-persistent pulmonary hypertension of the newborn— when the elevated pulmonary vascular resistance and minimal blood flow to lungs that's present in the fetus continues in the newborn which leads to the R—>L shunt

What is PPHN caused by? Why? - Correct Answer-Meconium aspiration Sepsis Hypoxemia Acidosis These all cause further vasoconstriction the lungs which increases resistance and causes elevated pressure on the R side of the heart—blood then flows the path of least resistance which is through the PFO What clinical signs are associated with CDH? - Correct Answer-Polyhydramnios from abnormal placement of the intestines in the thoracic cavity Scaphoid abdomen Barrel-shaped chest Respiratory distress Decreased or absent breath sounds What does increased mean airway pressure do? - Correct Answer-Improves oxygenation and provides support to airway structures, preventing upper airway collapse and closure of alveoli What is iNO and why is it used? - Correct Answer-A selective pulmonary vasodilator, treats conditions like PPHN Time of effects for iNO - Correct Answer-Limited systemic effects because NO is inactivated when it reacts with hgb in the blood stream Side effects of iNO - Correct Answer-Hypotension Rebound pulmonary hypertension when therapy is withdrawn Hyperglycemia Increased bleeding time Platelet malfunction Contraindications of ECMO - Correct Answer-< 2 kg < 34 weeks gestation Grade 1-2 IVH and higher Irreversible lung disease Severe coagulopathy How is BPD Treated? - Correct Answer-Minimize vent settings (because barotrauma) Use diuretics & steroids to minimize pulmonary edema Bronchodilators to minimize bronchoconstriction Increase calories, vitamin A&D Enrich formulas to boister lung tissue and allow healing and prevent rickets

Cxray for RDS - Correct Answer-Ground glass appearance, decreased lung volume, white out from fluid build up and collapsed alveoli Cxray of BPD - Correct Answer-Similar to RDS Coarse, irregular densities and air cysts Bubbly and hyperinflated Cardiomegaly Cxray of air leak syndrome - Correct Answer-May show air outside the lung Cxray of transient tachypnea of newborn - Correct Answer-Hyperinflation from air trapping and streaky infiltrates representing interstitial fluid Cxray of meconium aspiration syndrome - Correct Answer-Coarse patchy areas and hyperaeration Where does transplacental infection take place? - Correct Answer-Aspiration of amniotic fluid or from placenta to fetus CMV, rubella, toxo, varicella, listeria Where do parturition infections come from? - Correct Answer-Intrauterine infection when membranes are ruptured for prolong period or during passage through birthing canal Herpes simplex Chlamydia GBS Klebsiella E coli