Practice Test 1
A 1-year-old infant develops tachycardia, with continuous machine-like heart murmur. Widened pulse pressure and bounding peripheral pulses were noted by the nurse along with prominent supra-sternal and carotid pulsations. Which of the following conditions would the infant be likely to be suffering from?
- Patent ductusarteriosis
- Tricuspid atresia
Correct Answer: A. Patent ductusarteriosis
PDA is a condition where ductusarteriosis, fails to close after birth. Early symptoms are rare. In the first year of life there will be increased work of breathing and poor weight gain. In growing age, PDA can cause to congestive heart failure, if not treated. All the above-mentioned features in the infant are present in PDA and not in other options.
In apnea of prematurity, how long does a premature infant have cessation in breathing?
- More than 10 seconds
- More than 11seconds
- More than 12 seconds
- More than 14seconds
- More than 15seconds
Correct Answer: E. More than 15seconds
There are three types of apnea of prematurity: obstructive apnea, central apnea and mixed apnea. Obstructive apnea occurs when the infant's neck is hyper-flexed or hyper-extended. Central apnea occurs when there is a lack of respiratory effort in an infant. Sometimes, apnea of prematurity can be either obstructive or central, but they involve elements of both. Such a condition is called mixed apnea. In apnea of prematurity, the premature infant will have cessation of breathing which would last for more than 15 seconds. All other above-mentioned durations of apnea are not correct.
When a nurse assesses the caput succedaneum in a new-born, all of the following features will be present except
- Swelling extending across midline
- Swelling extending across suture line
- Swelling not diminishing within 2-3 days
- Presence of scalp swelling
- Swelling resolving in the first few days
Correct Answer: C. Swelling not diminishing within 2-3 days
Caput succedaneum involves presence of serosanguinous, extra-periosteal fluid collection. It does not have well-defined margins because of the pressure in the presenting part of the scalp against the dilated cervix during delivery. It also features with bleeding below the scalp and above the periosteum.
When can a nurse consider fetal scalp blood pH as abnormal?
- pH less than 7.20
- pH less than 7.30
- pH less than 7.35
- pH less than 7.40
- pH less than 7.60
Correct Answer: A. pH less than 7.20
A fetal scalp blood pH level less than 7.20 is considered abnormal. Generally, low pH shows that the fetus has less oxygen. The results of a fetal scalp pH sample need to be interpreted in labor. The results indicate that the fetus must be delivered fast by forceps or cesarean section. This test must be repeated a few times, when the labor is complicated, to continue to check on the well-being of the fetus.
Which of the following statements would the nurse consider as correct regarding small for gestational age babies?
- Small for gestational age baby’s birth weight will be below 2ndpercentile.
- Asymmetrical IUGR is more likely to have permanent neurological sequela.
- Small mothers tend to have small babies.
- SGA is not related to environmental factors.
- In IUGR, the fetus will be able to achieve its genetically determined potential size.
Correct Answer: C. Small mothers tend to have small babies.
Newborns reflect their mother's centile at birth and tend to graduate towards their mid-parental centile during one-year of life. Small for gestational age baby’s birth weight will be below 10th percentile. Symmetrical IUGR is more likely to have permanent neurological sequela. Environmental factors are a pre-determining factor for developing SGA. In IUGR, the fetus will be unable to achieve its genetically determined potential size.
Which one of the following would a nurse consider as the major contributor for the development of physiological jaundice in a neonate?
- Immature hepatic enzymes
- Enterohepatic circulation
- Increased bilirubin production
- Decreased hepatic bilirubin excretion
Correct Answer: C. Increased bilirubin production
The major contributor of physiological jaundice is increased bilirubin production. This leads to an increase in the hemoglobin levels at birth, with a less red-cell lifespan, while the other above-mentioned options do have a significant contribution for the development of physiological jaundice in the neonate.
Which one of the following is considered as the most important element in transferring an extremely low birth weight baby from a hospital without adequate NICU facilities to a hospital with a neonatal intensive care unit?
- Risk of transport accident
- High cost of neonatal transport
- Increased risk of intraventricular hemorrhage
- Increased morbidity
- Social disadvantage for family
Correct Answer: A. Risk of transport accident
Transportation carries the importance of risk to the baby and the retrieval staff. The rationale for transportation is based on the premises where the specialized NICU units reduce mortality and improve outcome, and these advantages outweigh the risk of transport and physical or social disadvantages for the family. Increased morbidity and intraventricular hemorrhage can be due to the underlying medical condition and are associated with the need for transportation.
A nurse cares for a term male neonate who is 15 minutes old, with birth weight 2700 g. He is receiving positive pressure ventilation through a T-piece of 70% oxygen and the saturation is 90%. The neonate has a cleft lip and palate with microcephaly; his eyes are small and he has small ears. The nurse suspects that the baby can have trisomy 13. There were no concerns regarding trisomy 13 during the pregnancy. Which one of the following is the most important step in the management of this baby?
- Resuscitation and stabilizing the baby; later shift to the nursery for investigations.
- Collect blood immediately for genetic studies and refer to a geneticist for the diagnosis.
- Continue respiratory support but do not intubate the neonate even if needed.
- Tell parents about the suspected diagnosis and seek their wishes for the ongoing resuscitation.
- Immediately cease resuscitation attempts and allow baby to die peacefully.
Correct Answer: A. Resuscitation and stabilizing the baby; later shift to the nursery for investigations.
The most important priority is the ongoing resuscitation and stabilization of the baby; this prevents further complications. Collection of blood is not done immediately for genetic studies, but this could be done at a later stage, after resuscitation. The baby may respond well to resuscitation, so active treatment needs to be continued until a formal diagnosis has been made. Hence, the parents would have time to assess for the impact of any underlying abnormality.
A nurse assesses a 3-hour-old female neonate, who is born at 25 weeks of gestation. She was in 30% oxygen on SIPPV + VG and needed pressures of 20/6 to obtain a tidal volume of 4 mL/kg. So she is ventilated for respiratory distress syndrome. After ventilation, she is with 100% oxygen and the ventilator alarms due to the maximum pressure limit. On examination, the nurse notices that the right chest of the neonate is full. On the right chest there is decreased air entry when compared to the left chest. The trachea is deviated to the left. Her pulse rate is 82 beats per minute and the oxygen saturation is 68%. Which one of the following is the important next step in the neonate’s management?
- Assist in the emergency thoracentesis on the right chest
- Re-intubate the neonate
- Increase the PEEP
- Increase the maximum pressure limit on the ventilator
- Arrange for an urgent chest radiograph
Correct Answer: A. Assist in the emergency thoracentesis on the right chest
The neonate has a right tension pneumothorax and is now in extremis. The emergency measure is to resolve the pneumothorax immediately. Re-intubating the neonate will delay the necessary treatment. Increasing the PEEP will not resolve the problem, and increasing the maximum pressure will exacerbate the pneumothorax. Sending the neonate for a chest radiograph will delay emergency treatment.
A nurse assists a doctor in resuscitating a 34 week female infant who is born by emergency lower segmental caesarean section after a large ante partum hemorrhage. The neonate is now 4 minutes old and the doctor informs that 1 minute ago he administered adrenaline through an endo-tracheal tube. The size of the tube is 3.5cm, and it is inserted up to 9 cm. The neonate is receiving chest compressions from the nurse and ventilation in 100% oxygen from the doctor. There is no heart rate. The nurse confirms that the ET tube is correctly placed. Which one of the following is the appropriate next step in management of the neonate?
- Call for the neonatal consultant
- Insert umbilical venous catheter to administer an IV adrenaline
- Give a second dose of adrenaline through the ETT
- Seek parental advice for continuing resuscitation
- Stop resuscitation
Correct Answer: B. Insert umbilical venous catheter to administer an IV adrenaline
Adrenaline must be administered through IV; here first dose is given through the endo-tracheal tube. The next step is arranging for an emergency UVC insertion. The second dose should be given through the UVC. Extra time must not be wasted by giving another dose through the ETT. Neonatal consultation and speaking with the parents are important but emergency treatment is the priority until extra help arrives. Most guidelines recommend stopping the resuscitation attempts after 10 minutes when there are no signs of life.
A neonate has jaundice. The nurse notices clay-white stools. On liver biopsy, giant cells are noted. Which of the following would the neonate most likely be suffering from?
- Extra-biliary atresia
- Physiological jaundice
- Neonatal hepatitis with physiological jaundice
- Neonatal hepatitis with extra-biliary atresia
- Bile-duct stenosis
Correct Answer: D. Neonatal hepatitis with extra-biliary atresia
Liver biopsy is essential in differentiating extra-hepatic and intra-hepatic causes of neonatal cholestasis. Biliary atresia has ductular proliferation and fibrosis. Neonatal hepatitis has alterations in lobular architecture with focal hepato-cellular necrosis. Giant cells with ballooning of cytoplasm are seen in neonatal hepatitis. The other above-mentioned diseases are not seen with giant cells in liver biopsy.
Which is the commonest tumor associated with acquired pure red cell aplasia?
- Bronchogenic carcinoma
- Hepatic carcinoma
- Hodgkin’s Lymphoma
Correct Answer: D. Thymoma
Pure red-cell aplasia is associated with SLE, CLL, lymphoma and thymoma. Thymoma originates from the thymus. It is associated with the neuromuscular disorder myasthenia gravis. Thymoma is seen in 15% of patients with myasthenia gravis. Thymomas can be surgically removed. In the rare case of a malignant tumor, chemotherapy is used for treatment.
Which one of the following is considered as a fatal complication of epiglottitis?
- Otitis media
Correct Answer: B. Asphyxia
Epiglottitis commonly affects children. It presents with fever, difficulty in swallowing, hoarseness of voice, and typical stridor. Stridor is a sign of upper airways' obstruction. The child appears ill and anxious. The early symptoms are insidious. Rapid progression leads to swelling of the throat which leads to cyanosis and asphyxiation. Asphyxia is a fatal condition. The other above-mentioned conditions are not fatal complications.
Which of the following viral infections of childhood is related to bronchiectasis?
Correct Answer: B. Measles
Most cases with bronchiectasis have recurrent episodes of other respiratory infections. They include bronchiolitis, bronchitis, post-measles, cystic fibrosis and pneumonitis. Bronchiectasis occurs in infancy and early childhood. The other above-mentioned diseases are not found to be related to bronchiectasis.
All of the following are the causes of IUGR except
- Chronic renal failure
- Gestational diabetes
Correct Answer: E. Gestational diabetes
Use of substances like tobacco and alcohol causes IUGR. Obstetrical causes of IUGR include PIH, multiple pregnancies and pre-eclampsia. Maternal under-nutrition, anemia and medical disorders of chronic nature like CHF and CRF are the causes of IUGR. Gestational diabetes is not known to cause IUGR.