NNP Comprehensive Exam Questions
and Answers
Which of the following would provide the weakest evidence for practice?
A.
Case study
B.
Case-control study
C.
Quasi-experimental study - ANS-A.
Level Evidence type I meta-analysis and/or systematic review of randomized-controlled
trials (RCT); II single RCT; III quasi-experiment (non-randomized); IV non-experimental
study (case-control, cohort, correlational); V systematic reviews of descriptive studies or
qualitative studies; VI single qualitative study or cross-section study (survey); VII expert
opinion, case reports, committee reports (Polit & Beck, 2018, pp. 23-34; Thomas, 2015,
p. 840).
An initial sign of hyperkalemia on an EKG is
A.
Peaked T waves
B.
Slurring of the QRS
C.
Ventricular fibrillation - ANS-A.
EKG changes are often the first sign of hyperkalemia. EKG findings are altered as the
serum K + rises, presenting with varying levels of peaked T waves (secondary to
increased repolarization of the cardiac tissue), flattened P waves, and increased PR
intervals (secondary to suppression of atrial conductivity). These changes are followed
by widening and slurring of the QRS complex (secondary to delay in ventricular
conduction as well as delays in myocardial conduction) with eventual development of
supraventricular tachycardia, ventricular tachycardia, bradycardia, or ventricular
fibrillation (Doherty, 2017, p. 308).
The Henderson-Hasselebalch equation is a negative logarithm that calculates the level
of
A.
Bicarbonate ions
B.
Dioxide ions
,C.
Hydrogen ions - ANS-C.
The Henderson-Hasselebalch equation calculates plasma pH. The pH is a negative
logarithm that measures the level of hydrogen ions (H+), which means that there is an
inverse relationship between the pH and H+. The pH decreases with a rise in H+ and
increases with a fall in H+. The pH remains normal when there is a balance in changes
of carbon dioxide (CO2) and bicarbonate (HCO3) (Barry, Deacon, Hernandez, & Jones,
2016, p. 145).
The neonatal nurse practitioner (NNP) knows that a serum peak level of a drug is
generally reflective of the infants:
A.
Excretion of metabolites
B.
Digestion of the drug
C.
Volume of distribution
answer - ANS-C.
Volume of distribution (Vd) is influenced by gestational age due to the rapid changes in
total body water and fluid shifts (Allegaert et al., 2018, p. 428; Wade, 2015, p. 666).
Infants with large extracellular fluid volumes have increased Vd for water-soluble drugs
and may reduce peak drug values and affect drug excretion (Blackburn, 2018, p. 198).
Decreased body fat in preterm and intrauterine growth-restricted infants decreases the
Vd for lipophilic drugs (Blackburn, 2018, p. 199).
Phase I drug metabolism reactions are mediated by
A.
Cytochrome P450 enzymes
B.
Hepatic oxidation metabolites
C.
Enzymatic reduction molecules - ANS-A.
Cytochrome P450 (CYP450) enzymes mediate Phase I metabolism and are present in
many tissues, but they are most highly concentrated in hepatic tissues (Allegaert et al.,
2018, pp. 655-657; McClary, 2015b, pp. 420-421).
The translocation of a drug from the site of administration into the systemic circulation is
called
A.
Absorption
B.
Distribution
C.
,Drug delivery
answer - ANS-A.
Pharmacokinetics is the process of drug
A.
Absorption, distribution, biotransformation, and excretion
B.
Adaptations made to physiological systems by the drugs
C.
Alterations, metabolism, and excretion in the cellular matrix - ANS-A.
Pharmacokinetics are the mathematical relationships between drug dose and blood
levels over time. Pharmacokinetic processes include absorption, distribution,
metabolism (biotransformation), and excretion (Allegaert et al., 2018, pp. 419-421;
Blackburn, 2018; pp. 180-181; Wade, 2015, p. 665).
Absorption is the process of drug movement from the administration site
(gastrointestinal, intravenous, intramuscular, intrapulmonary/inhaled, and
subcutaneous) across membranes and into the systemic circulation (Allegaert et al.,
2018, p. 419; Domonoske, 2015, pp. 220-221; Wade, 2015, p. 665).
8.
The recommendation for length of time to delay umbilical cord clamping after delivery of
a well newborn is
A.
0 to 20 seconds
B.
30 to 60 seconds
C.
90 to 120 seconds - ANS-B.
Delayed umbilical cord clamping is defined as a 30- to 60-second pause before
clamping the cord in order to allow for placental transfusion of blood to the infant
(Katheria & Finer, 2018, pp. 277-279).
9.
A newborn infant's oxygen saturation at 10 minutes after birth should be a minimum of
A.
80%
B.
85%
C.
90% - ANS-B.
Preductal oxygen levels generally should be above 85% to 95% after 10 minutes
(Pappas & Robey, 2015, p. 86).
10.
, The most appropriate value to use as an indicator of fetal and uteroplacental states is
the
A.
Arterial cord blood
B.
Placental cord volume
C.
Venous cord blood flow - ANS-A.
The umbilical cord arterial blood gas is more valuable than the umbilical cord venous
blood gas for determining neonatal acid-base status because it represents both the fetal
and uteroplacental states (Lyndon, O'Brien-Abel, & Rice Simpson, 2014, p. 481).
11.
The neonatal nurse practitioner (NNP) attends the vaginal delivery of a 38-week male
with a significant maternal history of uncontrolled type 1 diabetes. The large-for-
gestational-age (LGA) infant is vigorous with a lusty cry at delivery; however, upon
exam, there is asymmetrical movement of the upper extremities with the right more
flaccid than the left. The right hand exhibits a positive grasp reflex; therefore, the
NNPrecognizes the asymmetry is likely related to
A.
Barlow stretch
B.
Erb's palsy
C.
Klumpke palsy - ANS-B.
Erb's palsy—caused by injury to the fifth and sixth cervical nerve roots. Defining
characteristics of the affected arm include adducted, internally rotated, and extended at
the elbow with flexion of the wrist with an intact grasp, as known as the "waiter's tip"
position. The infant may have a normal grasp with absent Moro reflex. Intervention
includes gentle handling of the affected arm and gentle passive range of motion to
prevent contractures of the shoulder, elbow, forearm, and hand. Outcomes depend on
nerve root involvement; most infants achieve functional improvement by 3 months of
age. If improvement is not seen by 3 months, surgical intervention may be necessary
(Abdulhayoglu, 2017, p. 71; Manguten, Pappala, & Prazad, 2015, p. 419; Tappero,
2019, pp. 155-156; White & Goldberg, 2018, p. 1359).
12.
A 1-week-old infant presents to the primary care provider (PCP) for the first well-child
check. The PCPnotes the infant is unable to turn the head to the right, and a mass is
palpated on the left side of his neck. The PCP suggests physical therapy for the infant,
explaining to the mother that the infant likely has
A.
Clavicular fracture
B.
Erb's palsy
C.
and Answers
Which of the following would provide the weakest evidence for practice?
A.
Case study
B.
Case-control study
C.
Quasi-experimental study - ANS-A.
Level Evidence type I meta-analysis and/or systematic review of randomized-controlled
trials (RCT); II single RCT; III quasi-experiment (non-randomized); IV non-experimental
study (case-control, cohort, correlational); V systematic reviews of descriptive studies or
qualitative studies; VI single qualitative study or cross-section study (survey); VII expert
opinion, case reports, committee reports (Polit & Beck, 2018, pp. 23-34; Thomas, 2015,
p. 840).
An initial sign of hyperkalemia on an EKG is
A.
Peaked T waves
B.
Slurring of the QRS
C.
Ventricular fibrillation - ANS-A.
EKG changes are often the first sign of hyperkalemia. EKG findings are altered as the
serum K + rises, presenting with varying levels of peaked T waves (secondary to
increased repolarization of the cardiac tissue), flattened P waves, and increased PR
intervals (secondary to suppression of atrial conductivity). These changes are followed
by widening and slurring of the QRS complex (secondary to delay in ventricular
conduction as well as delays in myocardial conduction) with eventual development of
supraventricular tachycardia, ventricular tachycardia, bradycardia, or ventricular
fibrillation (Doherty, 2017, p. 308).
The Henderson-Hasselebalch equation is a negative logarithm that calculates the level
of
A.
Bicarbonate ions
B.
Dioxide ions
,C.
Hydrogen ions - ANS-C.
The Henderson-Hasselebalch equation calculates plasma pH. The pH is a negative
logarithm that measures the level of hydrogen ions (H+), which means that there is an
inverse relationship between the pH and H+. The pH decreases with a rise in H+ and
increases with a fall in H+. The pH remains normal when there is a balance in changes
of carbon dioxide (CO2) and bicarbonate (HCO3) (Barry, Deacon, Hernandez, & Jones,
2016, p. 145).
The neonatal nurse practitioner (NNP) knows that a serum peak level of a drug is
generally reflective of the infants:
A.
Excretion of metabolites
B.
Digestion of the drug
C.
Volume of distribution
answer - ANS-C.
Volume of distribution (Vd) is influenced by gestational age due to the rapid changes in
total body water and fluid shifts (Allegaert et al., 2018, p. 428; Wade, 2015, p. 666).
Infants with large extracellular fluid volumes have increased Vd for water-soluble drugs
and may reduce peak drug values and affect drug excretion (Blackburn, 2018, p. 198).
Decreased body fat in preterm and intrauterine growth-restricted infants decreases the
Vd for lipophilic drugs (Blackburn, 2018, p. 199).
Phase I drug metabolism reactions are mediated by
A.
Cytochrome P450 enzymes
B.
Hepatic oxidation metabolites
C.
Enzymatic reduction molecules - ANS-A.
Cytochrome P450 (CYP450) enzymes mediate Phase I metabolism and are present in
many tissues, but they are most highly concentrated in hepatic tissues (Allegaert et al.,
2018, pp. 655-657; McClary, 2015b, pp. 420-421).
The translocation of a drug from the site of administration into the systemic circulation is
called
A.
Absorption
B.
Distribution
C.
,Drug delivery
answer - ANS-A.
Pharmacokinetics is the process of drug
A.
Absorption, distribution, biotransformation, and excretion
B.
Adaptations made to physiological systems by the drugs
C.
Alterations, metabolism, and excretion in the cellular matrix - ANS-A.
Pharmacokinetics are the mathematical relationships between drug dose and blood
levels over time. Pharmacokinetic processes include absorption, distribution,
metabolism (biotransformation), and excretion (Allegaert et al., 2018, pp. 419-421;
Blackburn, 2018; pp. 180-181; Wade, 2015, p. 665).
Absorption is the process of drug movement from the administration site
(gastrointestinal, intravenous, intramuscular, intrapulmonary/inhaled, and
subcutaneous) across membranes and into the systemic circulation (Allegaert et al.,
2018, p. 419; Domonoske, 2015, pp. 220-221; Wade, 2015, p. 665).
8.
The recommendation for length of time to delay umbilical cord clamping after delivery of
a well newborn is
A.
0 to 20 seconds
B.
30 to 60 seconds
C.
90 to 120 seconds - ANS-B.
Delayed umbilical cord clamping is defined as a 30- to 60-second pause before
clamping the cord in order to allow for placental transfusion of blood to the infant
(Katheria & Finer, 2018, pp. 277-279).
9.
A newborn infant's oxygen saturation at 10 minutes after birth should be a minimum of
A.
80%
B.
85%
C.
90% - ANS-B.
Preductal oxygen levels generally should be above 85% to 95% after 10 minutes
(Pappas & Robey, 2015, p. 86).
10.
, The most appropriate value to use as an indicator of fetal and uteroplacental states is
the
A.
Arterial cord blood
B.
Placental cord volume
C.
Venous cord blood flow - ANS-A.
The umbilical cord arterial blood gas is more valuable than the umbilical cord venous
blood gas for determining neonatal acid-base status because it represents both the fetal
and uteroplacental states (Lyndon, O'Brien-Abel, & Rice Simpson, 2014, p. 481).
11.
The neonatal nurse practitioner (NNP) attends the vaginal delivery of a 38-week male
with a significant maternal history of uncontrolled type 1 diabetes. The large-for-
gestational-age (LGA) infant is vigorous with a lusty cry at delivery; however, upon
exam, there is asymmetrical movement of the upper extremities with the right more
flaccid than the left. The right hand exhibits a positive grasp reflex; therefore, the
NNPrecognizes the asymmetry is likely related to
A.
Barlow stretch
B.
Erb's palsy
C.
Klumpke palsy - ANS-B.
Erb's palsy—caused by injury to the fifth and sixth cervical nerve roots. Defining
characteristics of the affected arm include adducted, internally rotated, and extended at
the elbow with flexion of the wrist with an intact grasp, as known as the "waiter's tip"
position. The infant may have a normal grasp with absent Moro reflex. Intervention
includes gentle handling of the affected arm and gentle passive range of motion to
prevent contractures of the shoulder, elbow, forearm, and hand. Outcomes depend on
nerve root involvement; most infants achieve functional improvement by 3 months of
age. If improvement is not seen by 3 months, surgical intervention may be necessary
(Abdulhayoglu, 2017, p. 71; Manguten, Pappala, & Prazad, 2015, p. 419; Tappero,
2019, pp. 155-156; White & Goldberg, 2018, p. 1359).
12.
A 1-week-old infant presents to the primary care provider (PCP) for the first well-child
check. The PCPnotes the infant is unable to turn the head to the right, and a mass is
palpated on the left side of his neck. The PCP suggests physical therapy for the infant,
explaining to the mother that the infant likely has
A.
Clavicular fracture
B.
Erb's palsy
C.
