NNP Practice Exam (CCPR) | 175 Questions with 100% Correct Answers | Verified | 44 Pages

Indication of a plugged endotracheal tube is a. condensation in the endotracheal tube b. sudden decrease in chest wall movement c. tachycardia - correct answer b. sudden decrease in chest wall movement A neonate has a low T4 and elevated TSH. The appropriate next step would be a. begin thyroid hormone replacement therapy b. monitor the infant for lethargy, hypotonia and feeding difficulties c. recheck T4 and TSH levels at two months of age - correct answer a. begin thyroid hormone replacement therapy A 32 week gestational age male neonate has a 4 cm nontender mass in the right testicle. Differential diagnosis can be faciliated by a. palpation b. transillumination c. ultrasound evaluation - correct answer b. transillumination A neonate who has been in the NICU for two weeks is demonstrating habituation in response to environmental stimuli. Habituation is best defined as a. decreasing responsivity to external stimuli b. increasing attention to a new stimulus c. reacting vigorously to repeated stimuli - correct answer a. decreasing responsivity to external stimuli Which sense becomes the neurodevelopmental interface between the infant and the world at birth? a. Auditory b. Tactile c. Visual - correct answer b. Tactile A newborn with respiratory distress has a chest x-ray that reveals unilateral or bilateral streaky densities and confluent mottled, opacified areas. The nurse should anticipate that initial intervention should be a. initiation of antibiotics b. sepsis workup c. surfactant administration - correct answer b. sepsis workup A neonate born to a mother given Demerol three hours prior to delivery is apneic and cyanotic with heart rate of 74 at one hour after birth. The initial intervention should be a. administration of naloxone 0.1mg/kg b. bag and mask ventilation c. placement of endotracheal tube - correct answer b. bag and mask ventilation The best recommendation for treatment of intraventricular hemorrhage is a. management of ensuing problems b. fluid restriction c. Dopamine for blood pressure support - correct answer a. management of ensuing problems Which congenital heart defect is suspected when a systolic murmur is heard at the location noted on the diagram? a. Atrial septal defect b. Pulmonary valve stenosis c. Ventricular septal defect - correct answer c. Ventricular septal defect A two day old neonate has an abdominal mass. The most likely cause is a. adrenal hemorrhage b. polycystic kidney c. volvulur - correct answer b. polycystic kidney Nasal septum dislocation can be differentiated from normal variant of a misshapened nose by performing a. a compression test b. sinus transillumination c. x-ray - correct answer a. a compression test Orotracheal intubation is preferable to nasotracheal intubation during acute neonatal resuscitation because a. a smaller size endotracheal tube can be utilized b. it can be performed without additional equipment c. the endotracheal tube is easier to stabilize - correct answer b. it can be performed without additional equipment Following a traumatic delivery, a neonate's arm falls motionless along the side of the body and is rotated inwards. Extension of the forearm is present but there is no limitation on the movement of the hand. Once localized edema and pain diminished, the neonate should be referred for a. casting of the affected limb b. physical therapy c. surgical repair - correct answer b. physical therapy On physical examination of a 4100 gm male neonate, a firm scrotal mass is palpated. The next step in the evaluation is a. transillumination b. ultrasound c. x-ray - correct answer a. transillumination The absence of which reflex distinguishes total brachial plexus palsy from Erb's palsy? a. Grasp b. Moro c. Radical - correct answer a. Grasp A Neuromuscular development characteristic of prematurity includes increased a. heel to ear resistance b. hip flexion and adduction c. popliteal angle - correct answer c. popliteal angle An infant is noted to have vertebral anomalies, a single umbilical artery, and a tracheoesophageal fistula. What studies should you consider obtaining? a. echocardiogram b. eye exam c. renal ultrasound - correct answer c. renal ultrasound The decreased ability of the preterm neonate to produce heat to maintain normal body temperature is most related to a. decreased thermal receptors in the skin b. large surface skin area relative to body mass c. limited subcutaneous tissue and brown fat stores - correct answer c. limited subcutaneous tissue and brown fat stores The nurse should recognize that the auditory sounds of the NICU can compromise a neonate's neurobehavioral development and that most noise is produced by a. equipment b. exogenous sources c. staff - correct answer c. staff Pro-coagulation factors II, VII, IX and X are activated by a. fibrinogen maturation b. prothrombin c. vitamin K - correct answer c. vitamin K The skin barrier function in the 25 week gestation neonate may take up to how many weeks to mature? a. 2 weeks b. 4 weeks c. 8 weeks - correct answer c. 8 weeks Which of the following is a true statement regarding neonatal hyperbilirubinemia? a. Conjugated bilirubin is reabsorbed in the intestine b. Newborn infants produce more bilirubin per day than adults c. In VLBW infants, albumin has an increased affinity for bilirubin - correct answer b. Newborn infants produce more bilirubin per day than adults Neonates born to mothers with uncontrolled phenylketonuria (PKU) are at increased risk for a. cardiac defects b. microcephaly c. prematurity - correct answer b. microcephaly The grief response associated with (permanent, progressive, recurring and cyclic) loss is a. anticipatory b. chronic grief c. chronic sorrow - correct answer c. chronic sorrow A neonate born at 36 weeks gestation weighing 3000 gm is at increased risk for a. jaundice b. patent ductus arteriosus c. polycythemia - correct answer a. jaundice The foundation for nursing education, practice and documentation is the a. nursing process b. nurse practice act c. standard of care - correct answer a. nursing process Definitive diagnosis of HIV infection in a neonate born to an HIV-positive mother requires a. detection of HIV-specific nucleic acid b. enzyme linked immunosorbent assay (ELISA) c. viral load assays - correct answer a. detection of HIV-specific nucleic acid The potent stimulant of smooth muscle contraction that is essential for ductus arteriosus closure is increased a. circulating prostaglandins b. oxygen tension c. pulmonary vascular resistance - correct answer b. oxygen tension The primary therapy for disseminated intravascular coagulation consists of a. heparin administration b. infusion of fresh frozen plasma c. treatment of the underlying disorder - correct answer c. treatment of the underlying disorder Intrauterine growth restricted infants are at risk for decreased glycogen stores because of a. altered regulation of insulin secretion in pancreatic beta cells b. hypoxia-induced increased catecholamine secretions c. inhibition of gluconeogenesis secondary to high insulin concentrations - correct answer b. hypoxia-induced increased catecholamine secretions The immunoglobulin that is secreted in breastmilk is a. IgA b. IgG c. IgM - correct answer a. IgA Language development delays are most likely noted in neonates exposed to maternal use of a. alcohol b. cocaine c. nicotine - correct answer > a. alcohol The Pierre Robin sequence may be a part of a syndrome such as a. Smith-Lemli-Opitz Syndrome b. Stickler Syndrome c. VACTERL - correct answer b. Stickler Syndrome The majority of hypertension in infants can be accounted for as a result of a. endocrine disorders b. intrinsic renal disease c. umbilical artery catheter complications - correct answer b. intrinsic renal disease An increase in cerebral blood flow can be expected in association with a. decreased PCO₂ b. decreased PaO₂ c. decreased Kt level - correct answer b. decreased PaO₂ Physiologic jaundice is due to a combination of increased bilirubin load to the liver and a. decreased excretion of bilirubin b. defective conjugation due to increased glucuronyl transferase c. increased hepatic uptake - correct answer a. decreased excretion of bilirubin When placing a neonate on an oxygen saturation monitor, the nurse should recognize that a primary factor in obtaining an accurate reading is a. adequate warming of the electrode b. calibration of the monitor c. perfusion status of the infant - correct answer c. perfusion status of the infant Anemia of prematurity is characterized by a low reticulocyte count and a. abnormal erythroid maturation b. compromised bone marrow production c. inadequate response to erythropoietin - correct answer inadequate response to erythropoietin Limiting factors when deciding whether a LBW infant should be immunized per the CDC immunization schedule include a. birthweight b. clinical condition c. gestational age - correct answer b. clinical condition The efficacy of phototherapy depends on a. adequate hydration of the infant b. amount of time the infant is exposed to phototherapy c. irradiance of the lights - correct answer c. irradiance of the lights Cardiac enlargement in neonates with congestive heart failure occurs due to volume overload or a. hypoxia b. increased blood flow diverted from extremities c. pressure overload - correct answer pressure overload Infants with bronchopulmonary dysplasia have increased energy needs. These increased needs may be as much as a. 10%-20% b. 20%-40% c. 40%-60% - correct answer b. 20%-40% Markers of impaired fatty acid oxidation in neonates include a. cardiomyopathy b. hyperketonuria c. lactic acidosis - correct answer cardiomyopathy Inborn errors of metabolism should be considered when the infant presents with a. alkalosis b. hyperglycemia c. seizures - correct answer c. seizures The best predictor of bilirubin toxicity is a. bilirubin-albumin ratio b. hearing impairment c. total serum bilirubin concentration - correct answer hearing impairment An infant who refers twice on an Auditory Brainstem Response test (ABR) should have a full scale auditory diagnostic evaluation by a. 2 months of age b. 3 months of age c. 4 months of age - correct answer b. 3 months of age The optimal time to perform a gestational age assessment for the neonate born at 26 weeks gestation is a. 48-72 hours of age b. after 72 hours of age c. within 12 hours of age - correct answer c. within 12 hours of age Lower fluid administration rates are associated with lower incidence of morbidity in neonates with a. enterostomies b. necrotizing enterocolitis c. omphalocele - correct answer necrotizing enterocolitis A preterm neonate who required resuscitation at birth is admitted to the neonatal intensive care nursery in stable condition. Care of this infant should include a. a chest x-ray to rule out pneumothorax b. insertion of urinary catheter to monitor output c. oral feeding to prevent hypoglycemia - correct answer a. a chest x-ray to rule out pneumothorax A preterm infant of a diabetic mother has experienced several seizures. The initial action that needs to be taken with this neonate is to a. assess for metabolic imbalances b. obtain ultrasound c. perform lumbar puncture - correct answer a. assess for metabolic imbalances Diagnosis of hypertelorism or hypotelorism is primarily based on the measurement represented by point a. A b. B c. C - correct answer A Preterm infants should receive the influenza vaccine at a. 3 months of age b. 6 months of age c. 12 months of age - correct answer b. 6 months of age Phototherapy is contraindicated with the following condition a. breast milk jaundice b. congenital erythropoietic porphyria c. hemophilla - correct answer congenital erythropoietic porphyria A woman on methadone wants to breastfeed. She should be advised that a. supervised methadone use is considered safe b. the baby should be weaned gradually to avoid withdrawal c. transfer of methadone via breast milk precludes breastfeeding - correct answer a. supervised methadone use is considered safe What are the protein requirements for term infants? a. 1-2 g/kg/d b. 2-2.5 g/kg/d c. 3-4 g/kg/d - correct answer 2-2.5 g/kg/d Criteria for successful weaning from an incubator to an open crib include that the infant a. has at least three days of consistent weight gain b. is medically stable c. weighs at least 1200 gm - correct answer b. is medically stable A chest x-ray of a neonate shows low lung volumes and a fine reticulogranular pattern of air density. This is consistent with a. immature lungs b. meconium aspiration c. neonatal pneumonitis - correct answer a. immature lungs A preterm neonate who has been in the neonatal intensive care unit for several months has just been weaned from a ventilator. The parents live several hundred miles away and have not been able to visit the unit on a regular basis. The mother picks up the infant, and the infant starts squirming and recoils from the mother's touch. The nurse should counsel the mother that these behaviors reflect a. a lack of bonding between mother and child b. detachment due to multiple care givers c. the infant's association of touch with pain - correct answer the infant's association of touch with pain A neonate is oliguric. A 10-20 mL/kg body weight test dose of isotonic solution is given IV over 1 hour. If the problem is prerenal, the urine output should a. decrease b. increase c. remain unchanged - correct answer b. increase Validity as applied to a research instrument demonstrates a. ability of the instrument to measure in a consistent manner b. degree to which the instrument measures what it was purported to measure c. how the instrument was able to correlate data it to the hypotheses - correct answer degree to which the instrument measures what it was purported to measure T lymphocytes develop and differentiate in the a. bone marrow b. lymph nodes c. thymus - correct answer thymus In the newborn a tense fontalle is a/an a. early sign of meninigitis b. late sign of meningitis c. sign of a subgaleal hemmorage - correct answer b. late sign of meningitis The mandatory diagnostic test for infants suspected of having congenital syphilis is a. CSF VDRL b. fluorescent treponemal antibody absorption c. serum VDRL - correct answer a. CSF VDRL There is an increased risk of hypochloremia in neonates who a. are asphyxiated at birth b. had prolonged diarrhea c. have been over-treated with diuretics - correct answer c. have been over-treated with diuretics Compared to indomethacin, ibuprofen reduces the incidence of side effects in which system? a. Gastrointestinal b. Hepatic c. Renal - correct answer c. Renal The American Academy of Pediatrics recommends discharge of the late preterm infant after a. 24 hours b. 48 hours c. 72 hours - correct answer b. 48 hours When meconium aspiration syndrome is suspected, x-ray findings that would be confirmatory for the condition are a. hyperexpansion b. peripherial air bronchograms c. reticulogranular pattern - correct answer hyperexpansion Prior to administration of sodium bicarbonate for resuscitation, the following should be established a. adequate ventilation b. correction of hypovolemic shock c. documentation of respiratory acidosis - correct answer a. adequate ventilation Which of the following statement describes high-frequency ventilation (HFV)? a. Assessment of chest wall vibration indicates lung compliance and effectiveness of ventilation b. HFV is most effective for disorders in which oxygenation is the major problem c. Provides adequate gas exchange using small tidal volume - correct answer Assessment of chest wall vibration indicates lung compliance and effectiveness of ventilation To decrease the chance that a PICC will advance into the jugular vein, the inserter should a. prevent the head from turning side to side b. turn the head away from the insertion site c. turn the head toward the insertion site - correct answer turn the head toward the insertion site A neonate is receiving hydrochlorothiazide PO 1 mg/kg every 12 hours. The nurse should understand that the pharmacologic action is a. affects chloride transport in the loop of Henle b. decreases calcium excretian c. inhibits sodium reabsorption in the distal nephron - correct answer inhibits sodium reabsorption in the distal nephron A newborn presents with phenotypic findings of down syndrome, ventricular hypertrophy, increased pulmonary markings and variable murmurs. These findings are suggestive of a. atrioventricular canal b. cor pulmonale c. total anomalus venous connection - correct answer a. atrioventricular canal A six day old neonate develops eyelid swelling with a purulent discharge. Gram negative intracellular diplococci are identified on gram stain. This conjunctivitis is caused by a. chlamydia b. gonorrhea c. herpes - correct answer gonorrhea Absence of the ileocecal valve in the neonate with short bowel syndrome can lead to a. bacterial overgrowth in the small bowel b. nutritional deficiencies and cholestasis c. watery or fatty diarrhea - correct answer bacterial overgrowth in the small bowel Hirschsprung's disease occurs due to a. abnormal gut motility b. enzyme deficiency c. ganglion cell deficiency - correct answer ganglion cell deficiency Neonatal hypocalcemia is most likely to occur with a. perinatal asphyxia b. placental insufficiency c. postmaturity - correct answer a. perinatal asphyxia A provider asks a nurse to obtain a signature on informed consent for surgery. The nurse's responsibility in this situation is to a. determine if patient was advised of the reasons, risks and benefits of the surgery b. clarify any last minute questions for the patient about the surgery c. insure at least two unbiased witnesses are present when the patient signs the form - correct answer a. determine if patient was advised of the reasons, risks and benefits of the surgery On physical examination, a neonate is suspected to have transient pustular melanosis. It is anticipated that aspirating the contents of the pustules will reveal a variable number of a. eosinophils b. neutrophils c. staphylococcus - correct answer neutrophils Which milk protein is most difficult to digest? a. casein b. lysozyme c. whey - correct answer a. casein The most prominent and sensitive skin thermal receptors are in the a. abdomen b. crown of head c. trigeminal area of the face - correct answer c. trigeminal area of the face An important point to remember in the interpretation of cord blood gas sample is a. oxygen levels are higher in the umbilical artery b. oxygen levels are higher in the umbilical vein c. oxygen levels are equal in the umbilical vein and artery - correct answer oxygen levels are higher in the umbilical vein In determining the Apgar score of a neonate, the following findings are noted: One minute Color: Pale; Heart rate: 40 bpm; Reflexes: No response; Tone: Limp; Respirations: Weak and irregular. Five minutes Color: Pink/blue extremities; Heart rate: 90 bpm; Reflexes: Grimace; Tone: Limp; Respirations: Weak and irregular. The Apgar scores are a. 2 at one minute and 4 at 5 minutes b. 2 at one minute and 5 at 5 minutes c. 3 at one minute and 6 at 5 minutes - correct answer a. 2 at one minute and 4 at 5 minutes An asymptomatic mother's hepatitis screen reveals that she is HBsAg positive. This neonate a. is not at risk since the mother is asymptomatic b. should be vaccinated at birth, 1 month and 6 months of age c. should not breastfeed - correct answer b. should be vaccinated at birth, 1 month and 6 months of age Specific mechanisms of immune response include a. alpha- and beta-interferon b. C3b complement c. T with B lymphcytes - correct answer c. T with B lymphcytes A neonate is born by emergency cesarean because of fetal-maternal hemorrhage. At delivery, resuscitation is required and the infant fails to respond to all appropriate resuscitation efforts. The next step in the resuscitation should be to administer a. epinephrine b. sodium bicarbonate c. volume expanders - correct answer volume expanders Common clinical manifestations consistent with ABO incompatibility include a. jaundice in the first 24 hours of life b. rapidly developing hemolysis c. severe hepatosplenomegaly - correct answer jaundice in the first 24 hours of life What must be monitored for in an infant with Beckwith-Wiedmann Syndrome? a. Detached retinas