ROADTRIP TO RNC-NIC WEEK 8 EXAM
An severely preterm newborn nearing discharge has high alkaline phosphatase
levels. What should the nurse include in the discharge education?
A. Avoid kangaroo care. B. Carefully handle the infant.
C. Suggest a soy-based formula. ANSWER B. Handle the infant as gently as
possible.
Rationale: The infant's history (extreme preterm) and laboratory results
(elevated alkaline phosphatase) indicate metabolic bone disease. The infant's
bones are fragile and readily fractured (for example, the limbs and ribs).
Kangaroo care is not contraindicated for metabolic bone disease.
A soy-based formula will not improve metabolic bone disease and may be
nutritionally inferior to what the infant is already consuming.
References: Halbardier, B. Fluid and electrolyte management. In Verklan, M.T.,
and Walden, M. (Eds.), Core Curriculum for Neonatal Intensive Care Nursing,
5th ed. St. Louis: Elsevier Saunders, 2015, pp. 146–161.
Which of the following statements about treating a newborn with a chest tube is
correct?
A. The chest tube is routinely milked and stripped to verify its patency.
B. Continuous bubbling in the water seal chamber indicates that the chest t
ube is functioning properly.
C. The drainage system's tube patency, fluctuation, and bubbling should be
monitored and documented every hour. - ANSWER C. The drainage system's
tube patency, fluctuation, and bubbling should be checked and documented
every hour.
, Rationale: Frequent monitoring and documenting of tube patency, fluid
oscillation within the drainage system, and the presence or absence of bubbling
in the water seal chamber are all critical components of chest tube care.
Continuous bubbling in the water seal chamber suggests an air leak; the source
could be the patient or the system.
If there are apparent clogs and detritus in the chest tube that are not free
flowing, moderate kneading, rather than stripping, may be needed.
Milking and stripping of the chest tube are unnecessary.
References: Spruill, C.T. Developmental assistance. In Verklan, M.T., and
Walden, M. (Eds.), Core Curriculum for Neonatal Intensive Care Nursing, 5th
ed. St. Louis: Elsevier Saunders, 2015, pp. 197–215.Gardner, S. L., Enzman-
Hines, M., & Nyp, M. Respiratory disorders. Gardner, S.L., Carter, B.S.,
Enzman-Hines, M., et al. (Eds.), Merenstein and Gardner's Handbook of
Neonatal Intensive Care, 8th ed. St. Louis: Elsevier, 2016, pp. 565-643.
Which of the following is the recommended treatment for ventilator-induced
respiratory alkalosis?
A. Increase ventilator rate.
B. Decrease the minute ventilation.
C. Lower positive-end expiratory pressure - ANSWER B. Reduce minute
ventilation
The ventilatory rate and tidal volume have a direct effect on PaCO2 readings.
When the ventilatory rate, and hence minute ventilation, is reduced, PaCO2
levels rise to help correct respiratory alkalosis.
An severely preterm newborn nearing discharge has high alkaline phosphatase
levels. What should the nurse include in the discharge education?
A. Avoid kangaroo care. B. Carefully handle the infant.
C. Suggest a soy-based formula. ANSWER B. Handle the infant as gently as
possible.
Rationale: The infant's history (extreme preterm) and laboratory results
(elevated alkaline phosphatase) indicate metabolic bone disease. The infant's
bones are fragile and readily fractured (for example, the limbs and ribs).
Kangaroo care is not contraindicated for metabolic bone disease.
A soy-based formula will not improve metabolic bone disease and may be
nutritionally inferior to what the infant is already consuming.
References: Halbardier, B. Fluid and electrolyte management. In Verklan, M.T.,
and Walden, M. (Eds.), Core Curriculum for Neonatal Intensive Care Nursing,
5th ed. St. Louis: Elsevier Saunders, 2015, pp. 146–161.
Which of the following statements about treating a newborn with a chest tube is
correct?
A. The chest tube is routinely milked and stripped to verify its patency.
B. Continuous bubbling in the water seal chamber indicates that the chest t
ube is functioning properly.
C. The drainage system's tube patency, fluctuation, and bubbling should be
monitored and documented every hour. - ANSWER C. The drainage system's
tube patency, fluctuation, and bubbling should be checked and documented
every hour.
, Rationale: Frequent monitoring and documenting of tube patency, fluid
oscillation within the drainage system, and the presence or absence of bubbling
in the water seal chamber are all critical components of chest tube care.
Continuous bubbling in the water seal chamber suggests an air leak; the source
could be the patient or the system.
If there are apparent clogs and detritus in the chest tube that are not free
flowing, moderate kneading, rather than stripping, may be needed.
Milking and stripping of the chest tube are unnecessary.
References: Spruill, C.T. Developmental assistance. In Verklan, M.T., and
Walden, M. (Eds.), Core Curriculum for Neonatal Intensive Care Nursing, 5th
ed. St. Louis: Elsevier Saunders, 2015, pp. 197–215.Gardner, S. L., Enzman-
Hines, M., & Nyp, M. Respiratory disorders. Gardner, S.L., Carter, B.S.,
Enzman-Hines, M., et al. (Eds.), Merenstein and Gardner's Handbook of
Neonatal Intensive Care, 8th ed. St. Louis: Elsevier, 2016, pp. 565-643.
Which of the following is the recommended treatment for ventilator-induced
respiratory alkalosis?
A. Increase ventilator rate.
B. Decrease the minute ventilation.
C. Lower positive-end expiratory pressure - ANSWER B. Reduce minute
ventilation
The ventilatory rate and tidal volume have a direct effect on PaCO2 readings.
When the ventilatory rate, and hence minute ventilation, is reduced, PaCO2
levels rise to help correct respiratory alkalosis.
