Question 1

A newborn has just been delivered. You notice a greenish-brown substance on the infant, and observe a vigorous cry and active movement. What is the appropriate way to manage this patient?

Accepted Answer

The presence of meconium-stained amniotic fluid with a vigorous infant does not require immediate suctioning. The infant should be dried and placed on the mother's chest for warmth and bonding.

Question 2

A newborn was found pulseless and apneic in his crib. After lengthy attempts at resuscitation, medical control has advised you to stop resuscitation. When you inform the parents, they become hysterical and the mother cries, "Give me my baby! I don't want you touching him!" You should:

Accepted Answer

In situations of infant loss, it is important to show compassion and allow parents to grieve. Handing the child to the mother and allowing the parents time alone with the child can be a part of the grieving process.

Question 3

You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action?

Accepted Answer

In a five-day-old infant, sleeping for 18 hours a day and having a rectal temperature of 100°F are both normal. It is not appropriate to administer fluids or acetaminophen without a clear indication. Undressing the infant and sponging him with tepid water may be appropriate for a fever, but 100°F is not considered a fever in a newborn. Therefore, reassuring the parents that the infant's sleep patterns and temperature are normal is the best course of action.

Question 4

All of the following are accurate methods for obtaining the heart rate of a newborn EXCEPT:

Accepted Answer

Palpating a brachial pulse is not considered the most accurate method for obtaining the heart rate of a newborn due to the small size and the potential difficulty in accurately palpating the pulse in such a small limb. Methods like using a pulse oximeter, 3-lead ECG, and auscultating heart tones are more reliable and accurate for measuring a newborn's heart rate.

Question 5

Immediately after delivery, a neonate is crying and moving his arms and legs, but is centrally cyanotic. You recognize:

Accepted Answer

The answer of Immediately after delivery, a neonate is crying...

Question 6

You are assessing a 1-minute APGAR score on a patient who has peripheral cyanosis and a heart rate of 98, who cried spontaneously after delivery, is actively moving his extremities, and has a strong cry. What is the APGAR score of this patient?

Accepted Answer

The patient has a heart rate of 98, cried spontaneously after delivery, is actively moving extremities, and has a strong cry, which all earn 2 points each. The peripheral cyanosis means that the patient will receive 1 point for color, for a total of 8 points.

Question 7

You are called to the home of a 72-hour-old infant whose mother is concerned because the infant has been "vomiting after she eats." Based on this information, which of the following should you include in your history and physical assessment?

Accepted Answer

Assessing the fontanels can provide information about the infant's hydration status and intracranial pressure, which are relevant in the context of vomiting.

Question 8

You are caring for a newborn who had prolonged respiratory distress and hypoxia following birth. You recognize that continued hypoxia and subsequent severe acidosis can cause:

Accepted Answer

Persistent fetal circulation, also known as persistent pulmonary hypertension of the newborn (PPHN), can occur following hypoxia and severe acidosis. This condition is characterized by the failure of the normal circulatory transition that occurs after birth, leading to continued high pulmonary vascular resistance and right-to-left shunting of blood, similar to fetal circulation patterns.

Question 9

Which of the following best describes Pierre Robin syndrome?

Accepted Answer

Pierre Robin syndrome is a congenital condition characterized by a small jaw (micrognathia), large tongue (macroglossia), and cleft palate.

Question 10

Which of the following statements is TRUE regarding the cardiac output of a neonate?

Accepted Answer

Newborns have a fixed stroke volume due to their undeveloped cardiovascular system, so their cardiac output depends mostly on heart rate.

Question 11

You have just assisted in the delivery of a full-term infant in the back of the ambulance. Ten minutes after delivery, you obtain vital signs on the newborn and find the following: heart rate 120, respirations 54, and SpO₂ of 90%. You recognize:

Accepted Answer

A heart rate of 120 and a respiratory rate of 54 are slightly elevated for a newborn, but not necessarily concerning. However, a SpO2 of 90% is below the normal range of 95-100% for newborns and indicates hypoxemia. This, combined with the elevated heart rate, raises the possibility of shock. Therefore, the best choice is to recognize the need for immediate supplemental oxygen to correct the hypoxemia and prevent further deterioration.

Question 12

At 90 seconds after birth, based on the following findings, which newborn does NOT require resuscitative efforts beyond routine care?

Accepted Answer

The newborn in option A has a heart rate of 100 beats per minute and a respiratory rate of 30 breaths per minute, which are both within the normal range for a newborn. Although there is peripheral cyanosis present, the overall APGAR score of 8 indicates that the newborn is in good condition and does not require resuscitative efforts beyond routine care. The other options have abnormal vital signs and/or lower APGAR scores, indicating a need for more extensive resuscitative efforts.

Question 13

Which of the following is TRUE regarding vaginal delivery?

Accepted Answer

During vaginal delivery, the compression of the infant's chest helps to expel amniotic fluid from the lungs, reducing the risk of respiratory distress. Infants delivered vaginally are not at greater risk of post-delivery complications compared to those delivered via cesarean section. Vaginal delivery does not stimulate the production of insulin in the newborn, and the closure of the foramen ovale after birth is not affected by the delivery method.

Question 14

Which of the following is NOT an option for prehospital vascular access in the newborn?

Accepted Answer

Femoral vein cannulation is not recommended in newborns due to the risk of injury to the femoral artery and hip joint. The best option for vascular access in a newborn is umbilical vein cannulation, followed by intraosseous needle placement in the proximal tibia, and lastly cannulation of a peripheral vein in an extremity.

Question 15

Factors that stimulate the newborn to take the first breath include all of the following EXCEPT:

Accepted Answer

Hypothermia, hypoxia, and acidosis are all factors that can stimulate the newborn to take the first breath. However, hyperglycemia is not a factor that directly stimulates the newborn to take the first breath.

Question 16

You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. After 30 seconds of drying and stimulation, the infant remains limp and cyanotic, with a pulse of 50. Which of the following is the most appropriate action to take at this point?

Accepted Answer

BIn this scenario, the infant is showing signs of significant distress, indicated by limpness, cyanosis, and a critically low heart rate (pulse of 50). Immediate action is required to support the infant's breathing and circulation. A) Beginning CPR with a ratio of 3 compressions to 1 ventilation is appropriate for neonates with a heart rate below 60 beats per minute despite adequate ventilation, as per resuscitation guidelines.B) Intubating the trachea and ventilating are critical steps for an infant not responding to initial stimulation and showing signs of significant respiratory distress or failure. This approach, along with reassessment and preparation for transport to a NICU, is essential for stabilizing the infant's condition.

Question 17

Which of the following is NOT a recommended method for assessing the heart rate of a newborn?

Accepted Answer

Palpating the carotid pulse is not recommended for assessing the heart rate of a newborn as it can cause pressure on the neck and potentially harm the baby. The recommended methods include palpating the umbilical pulse, auscultating heart sounds, and palpating a femoral pulse.

Question 18

In some cases, the spinal cord and associated structures of a newborn may be exposed. This abnormality is called a:

Accepted Answer

The abnormality described is a meningomyelocele, which is a type of neural tube defect where the spinal cord and its protective coverings protrude through a gap in the backbone.

Question 19

You have just assisted in the delivery of an approximately 4 kg newborn whose mother is a rather petite primapara. On assessment, you note that there is no spontaneous movement of the infant's right arm at the shoulder, but he moves the elbow and wrist. He otherwise exhibits vigorous movement and has a 1-minute APGAR score of 9. Which of the following should you suspect?

Accepted Answer

The lack of spontaneous movement of the infant's right arm at the shoulder is suggestive of a potential fractured clavicle, which is a common birth injury in large babies or petite mothers. The infant's ability to move the elbow and wrist suggests that the nerves to the arm are intact, but the fracture may be causing pain and limitation of movement at the shoulder joint. Neonatal abstinence syndrome would present with symptoms related to drug withdrawal in the infant, such as jitteriness, poor feeding, and respiratory distress. Spinal cord damage is unlikely to be present in the absence of any other neurologic symptoms, such as weakness or paralysis. Caput succedaneum refers to swelling of the soft tissues of the scalp and would not affect movement of the arm.

Question 20

You are resuscitating a 15-day-old infant who was found pulseless and apneic in her crib. Which of the following questions would be most helpful when obtaining a history from the parents?

Accepted Answer

The answer of You are resuscitating a 15-day-old infant who...

Quiz 3: Neonatology