CCPR Study Workbook Questions | 696 Questions with 100% Correct Answers | Verified

The neonate has a limited ability to ________urine. - correct answer concentrate The best time for alpha-fetoprotein screening is: - correct answer 15-22 weeks Low or high levels of alpha-fetoprotein are associated with chromosomal anomalies? - correct answer Low Nuchal lucency screening is useful in diagnosing: - correct answer trisomy 21 risk True or false: A negative contraction stress test is more reassuring than a nonreactive non-stress test. - correct answer True The biophysical profile is determined by what 5 factors? - correct answer Fetal tone, fetal HR, amniotic fluid volume, fetal breathing, fetal movement __________ decels result from cord compression. - correct answer Variable __________ decels are associated with utero-placental insufficiency. - correct answer Late _________ decels mirror uterine contractions in time of onset, duration and termination. - correct answer Early List etiologies of fetal growth restriction: - correct answer preeclampsia, placenta previa, maternal substance abuse, TORCH infections, chromosomal anomalies, congenital malformations Complications seen in infants of mothers with severe preeclampsia: - correct answer IUGR, Mag toxicity (hypotonia, resp depression), thrombocytopenia Neonates born to women receiving mag sulfate may have these rare abnormalities: - correct answer abnormalities in CA homeostasis, parathyroid abnormalities Apgar scoring elements: 5 - correct answer HR (absent/<100/>100), Respiratory effort, tone, grimace, color Difference between primary and secondary apnea: - correct answer Primary: inability to immediately spontaneously breath but responds to stim. Secondary: no response to two attempts of tactile stim. Guidelines for initiation of chest compressions for infant: - correct answer HR<60bpm after intubation & 30 seconds of ventilation with 100% fiO2 Correct rate & depth of compressions: - correct answer 90/min, 3 compressions per breath (one and two and three and..) recommended dose and strength of epinephrine for neonatal resuscitation? - correct answer 0.01-0.03mg/kg IV, 0.03-0.1mg/kg ETT. 1:10,000 0.1mg/mL concentration One minute Apgar scores correlate with: - correct answer umbilical cord blood pH & index of intrapartum depression. 5/10 min Apgar scores correlate with: - correct answer infants change in condition and adequacy of resuscitative effort When to discuss withholding/withdrawing treatment: - correct answer after 10 min of aggressive resuscitative effort with no evidence for other causes of newborn compromise. Assess GA & wishes of parents 5 etiologies of non-immune hydrops fetalis: - correct answer hypoplastic L heart, parvovirus, extra thoracic tumors, chromosomal (trisomy 21/18), congenital lymphatic dysplasia Delivery room management for fetal hydrops: - correct answer Intubations supplies, thoracentesis, paracentesis, thoracotomy, line placement, & subspecialty presence 5 Risk factors of birth trauma: - correct answer primiparity, small maternal stature, maternal pelvic anomalies, prolonged or precipitous labor, oligohydramnios ________ nerve palsy may result from lateral hyperextension of the neck. - correct answer Phrenic In Duchenne erb palsy, which reflexes are absent on the affected side? - correct answer moro, bicep, and radial reflexes (arm is adducted and internally rotated) Klumpke's palsy, what is absent? - correct answer grasp reflex What are two neonatal complications of maternal UTI? - correct answer preterm birth & neonatal sepsis What are two neonatal complications of maternal cigarette smoking? - correct answer increased perinatal mortality & IUGR What are some neonatal complications of maternal anemia? - correct answer stillbirth, IUGR, hydros fetalis, preterm birth, asphyxia What are some neonatal complications of maternal bleeding? - correct answer stillbirth, preterm birth, anemia Etiologies for SGA? - correct answer underweight Mom, maternal HTN, placenta previa, single umbilical artery, congenital infections, chromosomal anomalies Etiologies for LGA? - correct answer maternal diabetes, large parents, post-term, syndromes (beckwith-wiedemann) Factors that increase risk for premature birth? - correct answer low socioeconomic status, African American, <16yrs or >35years, placenta previa, abruption, IUGR, hydros What are the risks associated with oligohydramnios? - correct answer fetal demise, placental insufficiency, IUGR, renal agenesis, pulmonary hypoplasia, deformations What are the risks associated with multiple gestations? - correct answer IGUR, T-T transfusion, preterm birth, asphyxia, birth trauma What are the risks associated with polyhydramnios? - correct answer anencephaly, neuromuscular/CNS disorders, chylothorax, swallowing issues, neurotube defects Identify 5 problems associated with prematurity: - correct answer perinatal depression (apnea), RDS, PVL, IVH, hypotension & PDA Management of intrauterine growth restriction: - correct answer Determine cause, monitor fetal wellbeing, offer glucocorticoids for lung maturity, deliver with NICU team Short term outcomes of SGA/IUGR infants: - correct answer increased morbidity & mortality, poor postnatal growth, neurologic impairment, delayed cognitive development, poor academic achievement Long term outcomes of SGA/IUGR infants: - correct answer increased risk of coronary heart disease, HTN, diabetes, stroke, COPD, renal impairment, decreased reproductive function, psychosocial issues What is the significance of a split in the S2 heart sound? - correct answer evidence of presence of two semilunar valves Erythema toxicum is a rash filled with_________. - correct answer eosinophils Milia usually resolves when? - correct answer within the first week of life Dermal melanocytosis is _________ in color. - correct answer bluish Barlow maneuver: - correct answer 'clunk' causes posterior dislocation of unstable hip (congenital hip dysplasia) Ortolani maneuver: - correct answer Causes reduction of hip & 'click' (Congenital hip dysplasia) True or false: mobility of suture lines rules out craniosynotosis - correct answer true Cephalohematoma/Caput: which crosses suture lines? - correct answer Caput crosses suture lines ('cap'), cephalohematoma does not What etiologies should be considered when marked jitteriness occurs? - correct answer hypoglycemia, hypocalcemia, hypomagnesemia, withdrawal from opiates/cocaine/tobacco/SSRI Three drugs that are known human teratogens: - correct answer methotrexate, lithium, warfarin Physical findings found with Trisomy 13: - correct answer Growth restriction, cleft lip, small ears, short neck, microcephaly, hypertonia, seizures, apnea, ASD/VSD, multicystic kidneys, polydactyly Physical findings with trisomy 18: - correct answer IUGR, low set ears, microcephaly, hypertonia, apnea, valvular anomalies, omphalocele, renal anomalies, overlapping fingers, decreased subcutaneous fat Physical findings with trisomy 21: - correct answer epicanthal folds, neck folds, tongue thrusting, microcephaly, hypotonia, AV canal, VSD/ASD, duodenal atresia, palmar crease What physical finding warrants consideration of a muscle biopsy? - correct answer severe hypotonia (use in conjunction with nerve biopsy) Growth patterns in twin gestations diverge from singleton pregnancies in the _____ week of pregnancy. - correct answer 30th True or false: Mortality increases threefold and fourfold for triplets and quads respectively. - correct answer True Most common illicit drugs abused in the US: - correct answer marijuana, psychotherapeutics, cocaine, hallucinogens Clinical signs of withdrawal of alcohol: - correct answer hyperactivity, crying, irritability, poor suck, tremors, seizures, diaphoresis Clinical signs of withdrawal of barbiturates: - correct answer irritability, tremors, hyperacusis, excessive crying, vasomotor instability, diarrhea, restlessness, hypertonia, vommiting Clinical signs of withdrawal from diazepam: - correct answer hypertonia, poor suck, hypothermia, apnea, hyperreflexia, vomiting, tachypnea Three drugs utilized to treat neonatal abstinence syndrome: - correct answer opioids (morphine), methadone, phenobarbitals (if unable to wean after 3 weeks) Treat NAS scores > or = - correct answer 8 Increase meds for NAS score greater than 8 x _____ and wean for NAS scores <8 after ______hrs. - correct answer 2, 24-48 Substance exposed infants can breastfeed if: - correct answer Mom is in a program, mom as abstained for 90 days prior to delivery, no psych meds, negative urine tox, prenatal care, and no marijuana use Elements of NAS Score: - correct answer Cry: unable to self console in 15 seconds or up to 5 mins with intervention Feedings: excessive suck/uncoordinated, gulping, not breathing Fever: 37.2-38.3, or 38.4 or higher Moro reflex: elicit from quiet infant, clonus of hands/arms Muscle tone: total body rigidity at rest Tremors: tremors without handling, 15-30 seconds after touch ___ out of ten ELBW infants are at risk for PDA. - correct answer 7/10 Respiratory support for ELBW infants: - correct answer CPAP for infants exposed to steroids (6-8cm). Conventional ventilation @ lowest tidal volume. Avoid hyperoxia. Surfactant administration for MAP's >7 & 30% fiO2. Surf immediately upon intubation. Target O2 range for ELBW infant: - correct answer 90-95% Start at what mL/kg/day fluid status for day one ELBW infant? - correct answer Start at 60ml/kg/day. Lipids should start on day ___, max of __mg/kg/day. - correct answer Lipids on day 2 (max 3mg/kg/day). When do you fortify to 24 cal for ELBW? - correct answer when enteral feeds reach 90-100mL/kg/day. Max feed volumes? - correct answer 150-160mL/kg/day Protein should be added to feeds to promote what? - correct answer somatic & head growth Signs of stress in preterm infants: - correct answer tachypnea, apnea, mottling, cyanosis, cough/sneeze, yawns, hiccups, spitting up, tremors, twitching, hyper/hypotonia, fussing, prolonged wakefulness Sound should not exceed ____ decibels around a preterm infant. - correct answer 45 decibels Factors that interfere with the premature infant's ability to maintain adequate body temperature: - correct answer higher ratio of skin surface to weight, increased permeability of skin (trans-epidermal H2O loss), decreased subcutaneous fat, decreased brown fat (decreased glycogen stores), poor vasomotor control Physiologic changes that occur with cold stress: - correct answer peripheral vasoconstriction, anaerobic metabolism, increased O2 consumption, chronic calorie loss (weight loss or inability to gain) Neutral thermal environment: - correct answer Environment in which infant has minimal heat production (measured by O2 consumption) and core temp is within normal range Radiational heat loss: - correct answer loss of heat to colder object without touching (ie isolette wall) Evaporative heat loss: - correct answer heat loss through conversion of H2O to gas (ie wet baby/bath) Convection heat loss: - correct answer heat lost to moving air (ie draft) Conduction heat loss: - correct answer heat lost to surface/object infant touches (ie cold mattress) The most common cause of respiratory infection in premature infants is: - correct answer respiratory syncytial virus When should preterm infants receive their hep B immunization? - correct answer 2kg, or DOL 30 regardless of weight or GA, or before DC Incidence of CP in VLBW infants: - correct answer <1500gs: 7-12% Incidence of CP in ELBW infants: - correct answer <1000g: 11-15% Hearing loss occurs in ___-____% of VLBW infants. - correct answer 2-11% VLBW infants should see a dentist at: - correct answer 12 months Dalton's law: - correct answer increased altitude is inversely related to decrease in barometric pressure and partial pressure of O2, which decreases alveolar tension. Leads to increased need of fiO2 Boyle's Law - correct answer as altitude increases, volume of gas expands. Gas trapped in closed spaces expand= increase in pneumothorax and GI distention. Management of an infant with suspected ductal dependent congenital heart disease during transport: - correct answer Initiate PGE (prostaglandin E) PRIOR to transport. S/E of PGE: apnea, fever, hypotension. Secure airway, assess for impaired perfusion. four central tenants of family centered care: - correct answer dignity & respect, information sharing, family participation in care, collaboration with family Indications for initiating parenteral nutrition: - correct answer infants <1500g, significant oral intake not anticipated 3-5 days, cardiac disease requiring ca supplement Peripherally infused TPN osmolality should be ___-___osm/L. - correct answer 300-900osm/L True/False: Peripheral solutions cannot adequately support growth in ELBW infants. - correct answer True Glucose needs in preterm infant: - correct answer need higher glucose because of higher brain to body weight ratio & higher energy needs. Initial GIR should be: - correct answer 4-8mg/kg/min Three signs of glucose intolerance: - correct answer hyperglycemia, secondary glucosuria with osmotic diuresis True or false: the amount of calcium and phosphorus that can be administered by IV is limited by the precipitation of calcium phosphate. - correct answer True ___________ and ________ should be withheld in PN feedings for infants with cholestatic liver disease. - correct answer Copper & manganese ________ is not routinely added to PN but should be considered with infants requiring long-term PN. - correct answer Carnitine Three complications of parenteral nutrition: - correct answer cholestasis (reduced bile flow), metabolic bone disease, metabolic abnormalities (increased BUN (azoemia), hyper ammonia, hyperchloremic metabolic acidosis (from bicarb loss) Three benefits of trophic feedings: - correct answer improved levels of gut hormones, decreased feeding intolerance, improved weight gain Criteria for transpyloric feedings: - correct answer intolerance to naso/oralgastric feedings, increase risk of aspiration, severe gastric retention & regurg, anatomic abnormalities (microgastria) Formula for gastroesophageal reflux: - correct answer standard formula or enfamil AR Formula for cystic fibrosis: - correct answer semi-elemental formula containing reduced LCT with MCT Formula for baby with cow's milk allergy: - correct answer extensively hydrolyzed protein Formula for baby with renal insufficiency: - correct answer standard formula Formula for baby with chylothorax: - correct answer significantly reduced LCT with supplemental MCT Nutritional management of infant with NEC: - correct answer Provide complete PN during acute phase followed by gradual intro to enteral feeds after stabilization. Start 10-20mL/kg/day and advance by 10mL/kg/day q12-24hrs. Nutritional management for babies with BPD: - correct answer Increased caloric requirement