Neonatal Intensive Care Nurse Exam Neonatal Respiratory Management 2 — Questions and Answers
Question 1: Which arterial blood gas value indicates respiratory acidosis in a neonate?
- pH 7.25, PaCO2 58 mmHg (Correct answer)
- pH 7.38, PaCO2 40 mmHg
- pH 7.50, PaCO2 28 mmHg
- pH 7.45, PaCO2 35 mmHg
Correct answer: pH 7.25, PaCO2 58 mmHg
Respiratory acidosis is characterized by a low pH (<7.35) with an elevated PaCO2, indicating inadequate ventilation.
Question 2: High-frequency oscillatory ventilation (HFOV) is distinguished from conventional ventilation by:
- Using very small tidal volumes at high frequencies (Correct answer)
- Delivering larger breaths less frequently
- Requiring higher FiO2 settings
- Not requiring PEEP
Correct answer: Using very small tidal volumes at high frequencies
HFOV delivers very small tidal volumes (often less than dead space) at frequencies of 3–15 Hz to minimize lung injury.
Question 3: A nurse preparing to administer surfactant via ET tube should position the infant:
- Supine with head midline (Correct answer)
- Right lateral decubitus only
- Prone position
- Head elevated at 30 degrees
Correct answer: Supine with head midline
Supine with the head midline ensures the ET tube is centered and surfactant is distributed evenly to both lungs.
Question 4: Persistent pulmonary hypertension of the newborn (PPHN) is characterized by:
- Elevated pulmonary vascular resistance causing right-to-left shunting (Correct answer)
- Left-to-right shunting through a PDA only
- Low pulmonary arterial pressure
- Surfactant deficiency as the primary cause
Correct answer: Elevated pulmonary vascular resistance causing right-to-left shunting
PPHN involves failure of normal postnatal pulmonary vascular resistance reduction, causing right-to-left shunting through fetal channels.
Question 5: Inhaled nitric oxide (iNO) is used in the NICU primarily to treat:
- Persistent pulmonary hypertension (Correct answer)
- Respiratory distress syndrome
- Apnea of prematurity
- Bronchopulmonary dysplasia
Correct answer: Persistent pulmonary hypertension
iNO selectively dilates pulmonary vasculature, reducing pulmonary vascular resistance and improving oxygenation in PPHN.
Question 6: Which assessment finding best indicates a neonate requires suctioning of the airway?
- Audible secretions, increased work of breathing, or decreased SpO2 (Correct answer)
- Routine time-based schedule regardless of clinical status
- Heart rate above 150 bpm
- Temperature instability alone
Correct answer: Audible secretions, increased work of breathing, or decreased SpO2
Suctioning should be clinically indicated by signs of airway obstruction such as audible secretions, respiratory distress, or desaturation.
Neonatal Intensive Care Nurse Exam Neonatal Respiratory Management 2
Which arterial blood gas value indicates respiratory acidosis in a neonate?