NRP Questions and Answers Latest Update Graded A

NRP Questions and Answers Latest Update Graded A In NRP, the steps of intubation should ideally be completed within which duration? 30 seconds Which statement best describes normal transitional physiology at the time of birth? Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90% A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated? Insert a laryngeal mask During an intubation, you have a very clear view of the hypopharynx. Which of the following is the correct way to lift the tongue out of the way in order to expose the pharyngeal area? keep blade straight and forward. (first picture) You have determined a baby needs resuscitation at birth. What are the initial steps of newborn care? warm position head clear secretions dry stimulate Which statement describes recommended practice when using a pulse oximeter in the delivery room? Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation You are at the resuscitation of a newborn who is gasping and has a heart rate of 60 beats per minute. What is the most important action you can take? Provide positive-pressure ventilation You are practicing the use of an algorithm to direct the sequence of interventions to correct ventilation. In which situation will the placement of a laryngeal mask airway be useful? When positive-pressure ventilation with a face mask fails to achieve effective ventilation and intubation is not possible Before birth, fetal respiratory function is performed by the *placenta* During the resuscitation of a newborn, you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? 100 bpm You are called to attend to a newborn at birth. At the time the baby is delivered, which three questions should you ask to evaluate whether the baby can stay with his mother or be moved to a radiant warmer for further assessment? Is the baby pink? Is the baby breathing or crying? Is the amniotic fluid clear? Your team attends an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Start positive-pressure ventilation and check heart rate response after 15 seconds You are uncertain whether you have successfully intubated a newborn. Which of the following is an indication that the endotracheal tube is correctly placed in the trachea, and not in the esophagus? Carbon dioxide detector indicates the presence of expired carbon dioxide. What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room? Determine the color of the baby's chest and abdomen, and monitor for central cyanosis Remembering MR. SOPA helps your team correct problems with ventilation. Which of the following steps are included in MR. SOPA? Mask adjustment, re-position the babies head, suction the nose and mouth, open the babies mouth, pressure increase, alternative airway You are at a delivery of a baby born through meconium-stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? The baby should be brought to the radiant warmer for initial steps of newborn care. A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of bag-and-mask ventilation. Your team plans to intubate. Which of the following is a true statement regarding the procedure? The newborn's head should be positioned in a sniffing position for intubation. You have successfully intubated a newborn with an estimated 35-week gestational age newborn and an estimated birth weight of 2 kg. What is the correct tip-to-lip depth of tube insertion for correct placement in the mid-trachea? 8 cm What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 38 weeks and an estimated birth weight of 3200 grams? 1 What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks (estimated birth weight of 1,200 g)? 0 After what duration of time might it be reasonable to consider discontinuing resuscitation following complete resuscitation efforts with no detectable heart rate? 10 min For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated? 0.1 mL How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate? 1 min A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action? Stop chest compressions; continue positive-pressure ventilation. You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 beats per minute and the oxygen saturation is 90% in room air. The baby's respirations are labored. Which of the following is an appropriate action? Administer CPAP at 5 cm H20 pressure In NRP, when are chest compressions indicated? When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway. A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures? Respirations, heart rate, oxygen saturation In NRP, when coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? 30 breaths, 90 compressions Which of the following may be associated with delayed cord clamping in vigorous preterm newborns? Decreased need for blood transfusions IN NRP, When administering chest compressions and ventilation, the heart rate should be assessed... Every 45 to 60 seconds In NRP, when chest compressions are indicated, you should also consider Endotracheal intubation, if not already done A baby has been receiving PPV and chest compressions, her heart rate is now 110 bpm. Your team discontinues chest compressions. She begins to breathe spontaneously. What do you do next? Gradually discontinue PPV while monitoring breathing and heart rate You attend the birth of a baby with prenatally diagnosed congenital diaphragmatic hernia. After birth, you should Intubate the trachea and insert an orogastric tube into the stomach A mother had an emergency cesarean birth at 39 weeks' gestational because of sudden fetal bradycardia and a suspected placental abruption. After birth, the baby required extensive resuscitation including positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, the baby has poor tone, lethargy, and apnea. Which of the following statements is true? Promptly evaluate her for possible therapeutic hypothermia (cooling) treatment and contact the nearest cooling center. What is the appropriate technique to stimulate a baby to breathe? Gently rub the baby's back or extremities What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)? 2.5 mm Which of the following is an indication for endotracheal intubation? The need for positive-pressure ventilation lasting more than a few minutes What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps? Administration of positive-pressure ventilation that inflates the lungs Which statement best describes normal transitional physiology at the time of birth? Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. A newborn of 34 weeks' gestation is not breathing (apneic) at birth, does not respond to initial steps and requires positive-pressure ventilation. What concentration of oxygen should be used as you begin positive-pressure ventilation? 21-30% Your team attends an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Start positive-pressure ventilation and check heart rate response after 15 seconds A baby is born at 34 weeks' gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps? Initiative positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate. You are at a delivery of a baby born through meconium-stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? The baby should be brought to the radiant warmer for initial steps of newborn care. If a preterm birth is anticipated, at what temperature should the room be set? 23ºC to 25ºC (74° F - 77° F) Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn? The approach to decisions in the newborn should be guided by the same principles used for adults and older children. Which of the following is true about the preparation and resources needed for a very preterm birth? Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat. After chest compressions with coordinated ventilations are started, the heart rate should be assessed: after 60 seconds You are in the delivery room caring for a preterm newborn at 27 weeks' gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby's subsequent care? Monitor blood glucose levels because of the risk of hypoglycemia after birth. A baby born at 36 weeks' gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true? His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal. What is the preferred method for assessing heart rate during chest compressions? Electronic cardiac monitoring Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak. A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? Endotracheal tube inserted too deep A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to start PPV When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? 30 breaths, 90 compressions Epinephrine should be administered over the following timeframe Rapid push as quickly possible. What is an indication for volume expansion? The baby appears to be in shock (pale with weak pulses) and there is a history associated with fetal blood loss. A newborn is born cesarean due to chorioamnionitis, meconium stained amniotic fluid, apneic poor tone, meconium staining and a gray color. You quickly intubate and suction the trachea, none is below the cords. You reposition, dry, stimulate, but the newborn remains apneic with a heart rate of 40 bpm. What is the next step? Initiate effective PPV for 30 seconds and reassess the heart rate. How soon after delivery of epinephrine should you recheck the baby's heart rate? 1 minute oximeters are devices that measure the SPO2 and HR you have stimulated a newborn and suctioned her mouth. It is now 30 seconds after birth, and she is still apneic and pale. Her heart rate is 80. Your next action is to PPV What signs are monitored with an apgar score? and how many points for each 0-2 color heart rate reflex irritability muscle tone respiration What are the targeted pre-ductal SPO2 after birth? 1 minute 60-65% 2 minutes 65-70% 3 minutes 70-75% 4 minutes 75-80% 5 minutes 80-85% 10 minutes 85-90% when a suction catheter is used to clear the oropharynx of meconium before inserting an endotracheal tube, the appropriate size is ____F or ______F. 12 or 14 the air in the babys lungs causes the pulmonary arterioles to (relax/constrict) so that the oxygen can be absorbed from the alveoli and distributed to all organs relax If you need to give supplemental oxygen for longer than a few minutes the oxygen should be ___ and ____. heated and humidified A full-term baby is born by emergency cesarean delivery because of fetal bradycardia (Category III fetal heart rate tracing). The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process? Initiate positive-pressure ventilation and check for increasing heart rate A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated? insert a laryngeal mask What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room? Determine the color of the baby's chest and abdomen, and monitor for central cyanosis When should you consider using a volume expander? acute fetal maternal hemorrhage. When do you remove a LMA? When the baby establishes spontaneous breathing or when an endotracheal tube can be inserted. When removing, suction secretions from mouth and throat before deflating and removing device. How do you manage a meconium stained and vigorous newborn? The baby may stay with the mother and receive the normal initial steps. If needed simply use the bulb and syringe to gently clear mec stained secretions from the mouth and nose. How can you give free-flow oxygen from a self-inflating bag? Free flow oxygen may be given though the open reservoir (tail) on some self inflating bags If clearing secretions from airway only with suction catheter what should the negative pressure be set to? 80-100mmHg when occluded During PPV when do you check the babies HR? What are the next steps? 15 seconds after PPV. If increasing continuing PPV and re-check in 15 sec. If not, then if chest rising continue PPV for 15 sec and recheck, if no/no then MrSOPA When would you use a ECG instead of a pulse oximeter? if the baby heart rate is low or the baby has poor perfusion When do you start PPV? If the baby is not breathing (apnea), gasping or the heart rate is below 100bpm What volume expanders should be considered and at what dose? 0.9% NaCl, or packed RBC if donor unit has been cross matched. Dose 10mL/Kg How do you manage a meconium stained non -vigorous newborn? Use bulb syringe to clear secretions from mouth and nose and bring baby to radiant warmer to perform the initial steps of newborn care. If the baby is not breathing or HR<100 start PPV When are chest compressions indicated? If HR remains below 60bpm and after at least 30sec of effective PPV and 100% oxygen needs to be administered What is the rate of compressions? 90 compressions per minute, 30 ventilations, 120 "events" per cycle. 3:1 compression: Ventilation Rhythm. One and two and three and breath and... What is temp should the servo controlled at during a resuscitation? between 36.5 C and 37.5 C Dose for endotracheal epinephrine? Dose is 0.5-1ml/kg(Use a 3-5mLsyringe). Follow with several PPV