Deck 33: Newborn Assessment and Management

Question 1

Late clinical manifestations of an infant with respiratory distress include:
1) elevated diaphragm.
2) decreased respiratory rate.
3) CO₂ retention.
4) lethargy.

A)2, 3
B)1, 4
C)1, 2, 3
D)2, 3, 4

Answer 1

2, 3

Question 2

A neonatal patient has PPHN. What may develop as a consequence of this?

A) Cardiomegaly
B) Pulmonary embolism
C) Mucosal edema
D) Cardiac tamponade

Answer 2

Cardiomegaly

Question 3

Apnea of prematurity can be defined as:
1) respiratory pause causing bradycardia.
2) cycles of short breathing pauses followed by faster breathing.
3) no breathing for >20 seconds.
4) sudden apnea and death (crib death).

A)1, 4
B)2, 3
C)1, 3
D)3, 4

Answer 3

1, 3

Question 4

A premature infant has two pulse oximeters placed: one on the right hand and one on the left foot. The respiratory therapist notes that the reading on the right hand is consistently 12% greater than the reading on the left foot. Which of the following is the best interpretation of this finding?

A) The infant has left-sided intrapulmonary shunting.
B) The infant likely has pneumonia.
C) The infant is in septic shock with systemic capillary shunting.
D) The infant has persistent pulmonary hypertension of the newborn.

Question 5

When a neonate has PPHN, what structures does the blood flow through to bypass the lungs?
1) Ductus venosus
2) Foramen ovale
3) Hypogastric arteries
4) Ductus arteriosus

A)3, 4
B)1, 3
C)2, 4
D)1, 2, 4

Question 6

Apneic episodes in a premature neonate can be caused by which of the following?
1) Epiglottitis
2) Immature central nervous system
3) Immature airway receptors
4) Immature chemoreceptors

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 7

A premature infant is suspected of having persistent pulmonary hypertension of the newborn. How is this diagnosis confirmed?

A) Arterial blood gas analysis
B) Chest radiography
C) Pulmonary angiography
D) Echocardiography

Question 8

An infant in respiratory distress will often generate a high negative intrapleural pressure during inspiration. In comparison to an adult, this will result in:
1) cyanosis of dependent thoracic areas.
2) "seesaw" breathing pattern.
3) alveolar hyperinflation.
4) intercostal retractions.

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Question 9

A premature infant is found to be "bobbing" her head. This is important because it can be a sign of which of the following?

A) Hypoxemia
B) Renal failure
C) Intracranial hemorrhage
D) Respiratory distress

Question 10

Early clinical manifestations of an infant with respiratory distress include:
1) cyanosis.
2) substernal retractions.
3) expiratory grunting.
4) apnea.

A)1, 3
B)2, 4
C)2, 3, 4
D)1, 2, 3

Question 11

PPHN usually appears:

A) in utero during the last trimester.
B) within 1 hour of birth.
C) within the first 12 hours of birth.
D) between the first and sixth days of life.

Question 12

Which of the following can trigger apnea in the premature infant?
1) Micrognathia
2) Intracranial hemorrhage
3) REM sleep
4) Hyperthermia

A)2
B)3, 4
C)1, 2, 3
D)2, 3, 4

Question 13

A newborn's 5-minute Apgar score is 7. How should this be interpreted?

A) Normal adjustment to being born
B) Moderate distress; intubate the airway and suction the lungs
C) Moderate distress; administer supplemental oxygen
D) Severe distress; begin bag-mask resuscitation

Question 14

A neonate in respiratory distress will often dilate his/her nostrils to:

A) facilitate inspiration.
B) nurse more easily.
C) sneeze out amniotic fluid.
D) raise the intrapleural pressure.

Question 15

Respiratory causes of persistent pulmonary hypertension of the newborn (PPHN) include:
1) congenital heart disease.
2) hypoxia.
3) meconium aspiration syndrome (MAS).
4) respiratory distress syndrome (RDS).

A)2
B)3, 4
C)1, 3
D)2, 3, 4

Question 16

A neonatal patient is found to have grunting on expiration. What physiologic effect does this produce?

A) Increased vital capacity
B) Increased PaO₂
C) Decreased PaCO₂
D) Closes the ductus arteriosus