Neonatal Intensive Care Nurse Exam Neonatal Thermoregulation and Fluid Balance 2 — Questions and Answers
Question 1: A nurse notes a neonate's skin color is blue centrally including the lips and mucous membranes. This is classified as:
- Central cyanosis, indicating low arterial oxygen saturation (Correct answer)
- Acrocyanosis, a normal newborn variant
- Cutis marmorata from cold exposure
- Physiologic jaundice
Correct answer: Central cyanosis, indicating low arterial oxygen saturation
Central cyanosis involving mucous membranes indicates systemic hypoxemia and requires immediate assessment and intervention.
Question 2: Hyperkalemia in the first 72 hours of life in an extremely preterm infant is most likely caused by:
- Non-oliguric hyperkalemia from immature Na/K-ATPase pump activity (Correct answer)
- Excessive potassium supplementation
- Renal failure with oliguria
- Adrenal insufficiency
Correct answer: Non-oliguric hyperkalemia from immature Na/K-ATPase pump activity
ELBW infants frequently develop non-oliguric hyperkalemia due to immature Na/K-ATPase function causing potassium to shift from cells.
Question 3: The preferred method for monitoring core temperature in a NICU patient is:
- Axillary temperature with a digital thermometer (Correct answer)
- Rectal temperature for all neonates
- Skin temperature probe on the abdomen
- Tympanic thermometer
Correct answer: Axillary temperature with a digital thermometer
Axillary temperature is the safest and most clinically used method in neonates; rectal measurement risks perforation in fragile preterm infants.
Question 4: Hypocalcemia in a neonate born to a diabetic mother is related to:
- Hypomagnesemia impairing PTH secretion (Correct answer)
- Excessive calcium excretion
- Maternal calcium supplementation
- Vitamin D toxicity
Correct answer: Hypomagnesemia impairing PTH secretion
IDM neonates often have hypomagnesemia, which impairs PTH secretion and leads to secondary hypocalcemia.
Question 5: Daily weights in the NICU are most important for monitoring:
- Fluid balance, nutritional adequacy, and edema (Correct answer)
- Head circumference growth only
- Gestational age correction
- Medication dosing accuracy alone
Correct answer: Fluid balance, nutritional adequacy, and edema
Daily weights guide fluid management, detect fluid overload or dehydration, and assess nutritional support adequacy in NICU patients.
Question 6: Which intervention best prevents heat loss by evaporation immediately after birth for a premature infant?
- Immediately wrapping in a polyethylene plastic bag without drying (Correct answer)
- Vigorous drying with warm towels
- Placing under a radiant warmer without any covering
- Bathing immediately after birth
Correct answer: Immediately wrapping in a polyethylene plastic bag without drying
Polyethylene wrapping without drying prevents evaporative heat loss by retaining body moisture against the skin in preterm infants.
Neonatal Intensive Care Nurse Exam Neonatal Thermoregulation and Fluid Balance 2
A nurse notes a neonate's skin color is blue centrally including the lips and mucous membranes.
This is classified as: