Free CCNS Neonatal Practice Test
1. When conducting a research project to determine if the nurse turnover rate in the critical care unit is higher or lower than in other hospital units, which of the following comprises the dependent variable?
- Staff assignments
- Nurse turnover rate
- Full-time vs part-time
- Staff satisfaction
2. A mother brings her term infant (and first child) for an exam at 2 weeks after birth. The baby has poor skin turgor, face drawn, appears listless, and has not regained birth weight. The mother is breast-feeding. Which of the following first actions is most appropriate?
3. A 5-day-old neonate has been diagnosed with patent ductus arteriosus (PDA). Her heart rate is 185 bpm with a 4+ bounding pulse and respiratory rate is 76 per minute. Hepatomegaly is 4 cm below costal margin. The most likely treatment for the PDA is:
- Surgical repair
- Indomethacin or ibuprofen lysine.
- No specific treatment is necessary because the PDA will close.
4. A 5-day-old neonate with a PICC in place and an endotracheal tube for ventilation develops respiratory distress with tachypnea, hypoglycemia, sternal retractions, grunting respirations, hypoxemia, hypercapnia, and cyanosis. Breath sounds are diminished over the left lower lung and audible rales are present. Radiograph shows unilateral alveolar infiltrates. Which further laboratory tests are indicated to verify a diagnosis of pneumonia?
- WBC count and ESR.
- ESR, blood culture, and urinalysis.
- ABGs and culture from about PICC insertion site.
- CBC, blood culture, ABGs, and cultures of tracheal aspirate and cerebral spinal fluid.
5. A neonate with ABO incompatibility develops hyperbilirubinemia, which is treated with phototherapy. The infant is not anemic. What follow-up is advised for the next few weeks?
- Total serum bilirubin levels.
- Blood cell counts (Hgb and Hct).
- Electrolyte levels.
- White blood counts.
1. B: The dependent variable (the presumed effect) is the nurse turnover rate, which "depends on" other variables. The presumed causes/influences of this effect, such as staff assignments, are the independent variables. Variable refers to those things that can vary, and research looks at the ways in which variables interrelate. The variable of most concern to the researcher is the dependent variable, also referred to as the criterion variable, in order to determine how various independent variables can alter the dependent variable. There may be many independent variables which must be identified.
2. A: The mother should be questioned about her breast-feeding technique and frequency, and should be observed while breast-feeding the child. Since this is her first child, she may need further assistance in breast-feeding properly to ensure the infant receives adequate nutrition. While further tests may be indicated, these signs are indicative of dehydration and poor nutrition, so that should be dealt with first. As there are no other indications of neglect, referral to Child Protective Services is not appropriate at this time. Switching from breast milk to formula is rarely necessary if mothers receive adequate support and instruction.
3. B: Ibuprofen lysine or indomethacin (3 doses of either) is successful in causing PDA to close in 70% to 80% of infants. If the PDA remains open, then surgical repair may be indicated. Symptoms are usually evident at 4 to 7 days after birth. Mild cases may close without treatment, but clinically significant cases (HR greater than 170 bpm, respirations greater than 70/min, bounding pulses, and hepatomegaly greater than 3 cm below costal margin) require medical or surgical treatment. Prostaglandin is used to reopen a PDA.
4. D: A number of tests should be done to verify a diagnosis of pneumonia and rule out other disorders with similar symptoms, such as RDS and sepsis: CBC to indicate neutropenia or shift to left; blood culture to rule out septicemia; ABGs to determine presence and degree of metabolic acidosis; culture of tracheal aspirate for presence of organisms; and culture of cerebrospinal fluid to rule-out comorbid meningitis.
5. B: Because of increased rate of RBC breakdown, the neonate should be monitored with blood cell counts to assess anemia. About 20% to 25% of pregnancies involve ABO incompatibility, usually with the mother type O and the fetus A or B. Anti-A and anti-B antibodies occur naturally when a woman is exposed to A and B antigens in foods or bacteria, so these antibodies can cross the placenta and result in hemolysis of fetal RBC; however, the antibodies are relatively large and do not enter the fetal circulation easily. If fetal blood leaks into maternal blood (a common occurrence), then smaller antibodies form and these can cross the placenta more easily. Serious complications for the fetus are rare.
Last Updated: 07/05/2018