S.T.A.B.L.E. Study Guide Questions with Correct Answers., Exams of Study of Commodities

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S.T.A.B.L.E. Study Guide Questions with Correct

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A neonate with pneumothorax may exhibit? - ANS Increased work of breathing Bradycardia Asymmetric appearing chest Cyanosis Decreased femoral pulses An infant is tachypnea, tachycardia, and hypotonic. Temperature is 101.5F. CBC is ordered. Doctor says CBC is normal. What do you do? - ANS The infant’s clinical presentation is not being adequately considered. Do a work up and treatment for possible infection if indicated. A breastfeeding infant has vomited lime green emesis. The abdomen is not distended, infant is crying and irritable. What should you do? - ANS An upper gastrointestinal exam to evaluate for malrotation An infant underweight has a dex of 10mg. No signs of hypoglycemia. What do you do? - ANS Insert IV and give 2.8mL bolus of D10W, followed by an infusion of D10W at 80mL per day. Recheck glucose 15-30 minutes after the bolus. The purpose of brown fat is to - ANS generate heat when it is metabolized An infant developed respiratory distress and received blow by oxygen, then CPAP. The infant further deteriorated so PPV was initiated. You observe a shift in the point of maximal impulse to the right, a barrel chest, and a sunken abdomen. What do you suspect? - ANS Diaphragmatic hernia An infant that is breastfeeding well is hypotonic and has a heart rate of 200bpm, respiratory rate of 80, and weak central pulses. What do you do? - ANS Order CBC with differential, c-reactive protein and culture An infants condition: pale heart rate 180-200bpm prolonged capillary refill weak pulses respiratory distress What do you do? - ANS O negative packed red blood cells via 10mL/kg IV Arterial blood gas result: pH 7. PCO2 23

HCO3 12

What do you interpret? - ANS compensated metabolic acidosis An infant is born with a small chin and jaw, a large tongue, and has retractions. What should be done ASAP? - ANS Place the infant prone and assess whether additional airway support is required An infant is being treated for sepsis. CBC is ordered every eight hours. The absolute neutrophil count (ANC) on the CBC is: 3240 1050 540 This trend indicates a? - ANS increased risk of neutrophil depletion The immature to total ration (I/T) on the CBC (from previous question) is:

This trend indicates a? - ANS increasing percentage of mature neutrophils What may cause hypovolemic shock? - ANS placental abruption pneumothorax twin to twin transfusion syndrome PPV via bag mask or ET tube should be performed without delay if the infant is? - ANS gasping An infant that is feeding poorly has a week cry, hypotonia, tachypnea, absent femoral pulses, and a 6 second capillary refill time. Arterial gas is obtained with the following: pH 7. PCO2 25 HCO3 9. Base deficit - What is your diagnosis? - ANS ductual dependent congenital heart disease An infant born via vacuum with a shoulder dystocia is very sleepy, scalp bruising, weak pulses, hypotonic, weak cry, and swelling at sutures. What do you suspect? - ANS Subgaleal hemorrhage A mother has insulin dependent diabetes and elevated hemoglobin A1c levels. Her newborn weighs 5.1kg. What statement is true? - ANS The elevated hemoglobin A1c

levels and infants macrosomic size indicate the mother had poor glucose control during pregnancy. An infant born with meconium stained amniotic fluid has a temp of 97.3, 175bpm, and respiratory rate of 65. After a bath the infant has acrocyanosis, nasal flaring, grunting, and retractions. Vitals are temp of 95.5, 180bpm, and respiratory rate of 70. What is the clinical change related to? - ANS increased metabolic rate and oxygen consumption secondary to hypothermia How do you rewarm a hypothermic preterm baby? - ANS place the baby on a chemical thermal mattress and cover the infant with plastic from chin to feet A premie is born. Arterial cord pH is 6.95. APGARS are 2, 4, then 6. Infant is 1.2kg. 25 minutes later, arterial cord pH is 6.98. Transport is arranged. What is a true statement?

• ANS Post resuscitation stabilization should include protection from heat loss, establishment of IV access, and starting a D10W infusion. A pulse pressure is indicated by subtracting the diastolic blood pressure from the systolic blood pressure, what is a true statement about pulse pressure? - ANS A narrow pulse pressure may indicate poor cardiac output A premie has a temperature of 87.8F. What is a sign commonly associated with this body temperature? - ANS hypotension bradycardia bradypnea A newborn developed respiratory distress (tachypnea, grunting, nasal flaring, and retractions). O2 was administered via mask but SPO2 remained 80%. ET tube had to be inserted. What is your diagnosis? - ANS bacterial sepsis, congenital heart disease A 3kg infant requires intubation for severe respiratory distress. The ET tube is taped at 12 centimeters of the lip. The ET tube is most likely? - ANS too low An infant comes in from a delivery in a car. Infant is limp and cyanotic. He is intubated and receiving PPV. He is gasping and has no IV. What should be performed first? - ANS Clinically evaluate that the ET tube is in correctly and is secured. Check the heart rate and apply a pulse oximeter. Arterial blood gas reports: pH 7. PCO2 63 HCO3 23 What do you interpret? - ANS uncompensated metabolic acidosis

An infant has suspected pneumonia and is on a ventilator. Arterial blood gas reveals severe metabolic and respiratory acidosis and low arterial oxygen tension. What is a FALSE statement regarding this? - ANS Sodium bicarbonate should be given immediately to treat the acidosis Pre and post ductal saturation monitoring is ordered for an infant with suspected persistent pulmonary hypertension. Where will the two pulse oximeters be placed and what will each probe be measuring? - ANS Right hand (pre ductal saturation) Left foot (post ductal saturation) An infant develops respiratory distress. Right hand SPO2 reads 70%. When infant cries SPO2 raises to 96%. When not crying SPO2 drops. What is her condition? - ANS Choanal atresia Arterial blood gas result: pH 7. PCO2 36 HCO3 15 Interpretation? - ANS uncompensated metabolic acidosis A infant whose birthweight is at the 95th percentile for weight is at risk for? - ANS hypoglycemia due to hyperinsulinism A few hours after delivery a newborn is unresponsive, has tachypnea, hypothermia, hypotonia, and cyanosis. What is your concern? - ANS bacterial sepsis Infants of diabetic mothers are at increased risk for becoming hypoglycemic because they have? - ANS increased levels of insulin An infant is 96.8F 170bpm respiratory rate of 65 Should you bathe the infant at this time? - ANS No, the vital signs are not in a normal range Babies born between 34-36 weeks are at risk for: - ANS temp instability hypoglycemia respiratory distress apnea hyperbilirubinemia feeding difficulties

A 39 week gestation baby is born in the 4th weight percentile. Mother had hypertension and too no medication to treat it. Dex is 20mg. Why does the baby have hypoglycemia?

• ANS Chronic intrauterine stress from the maternal hypertension limited the fetus's ability to make and store glycogen for use after birth T or F Mild hypothermia stimulates norepinephrine release, which increases metabolic rate and brown fat metabolism - ANS T T or F Severe hypothermia slows heart rate and decreases cardiac output which leads to tissue hypoxia and dependence on anaerobic metabolism - ANS T T or F Hypothermia may cause pulmonary vasoconstrictiction and result in right to left shunting through the ductus arteriosus and or foramen ovale - ANS T A term baby with septic shock, 50th weight percentile, and arterial blood gas pH 7.15/ PCO2 38/ HCO3 13 is at risk for? - ANS hypoglycemia Arterial blood gas result: pH 7. PCO2 55 HCO3 14 The interpretation is? - ANS uncompensated mixed metabolic and respiratory acidosis Bacterial sepsis is suspected in a 3kg term infant with severe hypotension. The following lines are in place: umbilical artery catheter, umbilical venous catheter, and a peripheral IV in the hand. What action could cause harm to the patient? - ANS Infusing dopamine 10mcg/kg/minute via UAC