Neonatal Intensive Care Nurse Exam Neonatal Respiratory Management 1 — Questions and Answers
Question 1: A preterm infant at 28 weeks gestation is placed on mechanical ventilation. Which ventilator parameter directly controls oxygenation?
- FiO2 and PEEP (Correct answer)
- Rate and inspiratory time
- Tidal volume only
- Peak inspiratory pressure only
Correct answer: FiO2 and PEEP
FiO2 and PEEP are the primary ventilator parameters that control oxygenation in mechanically ventilated neonates.
Question 2: Which finding is the earliest sign of respiratory distress syndrome (RDS) in a newborn?
- Grunting on expiration (Correct answer)
- Central cyanosis
- Bradycardia
- Decreased tone
Correct answer: Grunting on expiration
Expiratory grunting is an early compensatory mechanism to maintain functional residual capacity in RDS.
Question 3: A nurse is caring for a neonate on CPAP. The target SpO2 range for a 26-week gestation infant is:
- 91–95% (Correct answer)
- 85–89%
- 96–100%
- 80–85%
Correct answer: 91–95%
The recommended SpO2 target for preterm neonates is 91–95% to balance adequate oxygenation with minimizing oxygen toxicity.
Question 4: Surfactant replacement therapy is MOST indicated for which condition?
- Respiratory distress syndrome (Correct answer)
- Transient tachypnea of the newborn
- Meconium aspiration syndrome
- Persistent pulmonary hypertension
Correct answer: Respiratory distress syndrome
Surfactant replacement therapy is the primary treatment for RDS caused by surfactant deficiency in preterm infants.
Question 5: During a ventilator assessment, the NICU nurse notes rising PaCO2 on blood gas. Which intervention addresses hypercapnia?
- Increase ventilator rate or tidal volume (Correct answer)
- Increase FiO2
- Increase PEEP
- Decrease inspiratory time
Correct answer: Increase ventilator rate or tidal volume
Hypercapnia (elevated PaCO2) is corrected by increasing minute ventilation through higher rate or tidal volume.
Question 6: A neonate develops a sudden deterioration in oxygen saturation, decreased breath sounds on the left, and shift of heart sounds to the right. What is the most likely diagnosis?
- Right-sided pneumothorax
- Left-sided pneumothorax (Correct answer)
- Pulmonary hemorrhage
- Pleural effusion
Correct answer: Left-sided pneumothorax
Decreased left breath sounds with rightward mediastinal shift indicates a left-sided pneumothorax causing tension physiology.
Neonatal Intensive Care Nurse Exam Neonatal Respiratory Management 1
A preterm infant at 28 weeks gestation is placed on mechanical ventilation.
Which ventilator parameter directly controls oxygenation?