Neonatal Nurse Practitioner Exam Cardiovascular Assessment and Management 2 — Questions and Answers
Question 1: A neonate with hypoplastic left heart syndrome (HLHS) becomes critically ill when the ductus closes. The primary reason is:
- The ductus was providing the only source of systemic blood flow (Correct answer)
- The ductus was providing pulmonary blood flow
- Closing the ductus reduces right heart preload
- The ductus was delivering oxygenated blood to the brain
Correct answer: The ductus was providing the only source of systemic blood flow
In HLHS, the underdeveloped left heart cannot support systemic circulation, so the ductus arteriosus provides the only route for oxygenated blood to reach the body.
Question 2: What is the hallmark finding on ECG in a neonate with complete heart block?
- Short PR interval with delta waves
- P waves that bear no relationship to QRS complexes (Correct answer)
- Prolonged QT interval
- ST elevation in all leads
Correct answer: P waves that bear no relationship to QRS complexes
Complete (third-degree) heart block shows P waves and QRS complexes firing independently, with no conduction between atria and ventricles.
Question 3: A neonate with supraventricular tachycardia (SVT) at a rate of 280 bpm and hemodynamic instability requires:
- Adenosine IV push as initial treatment
- Immediate synchronized cardioversion (Correct answer)
- Digoxin loading
- Oral propranolol
Correct answer: Immediate synchronized cardioversion
Hemodynamically unstable SVT requires immediate synchronized cardioversion; adenosine is used for stable SVT.
Question 4: Which echocardiographic finding is characteristic of total anomalous pulmonary venous return (TAPVR) with obstruction?
- Large left-to-right shunt at the atrial level
- Small right ventricle with left ventricular hypertrophy
- Severe pulmonary hypertension with right heart enlargement and small left heart (Correct answer)
- Dilated coronary arteries
Correct answer: Severe pulmonary hypertension with right heart enlargement and small left heart
Obstructed TAPVR causes pulmonary venous obstruction, severe pulmonary hypertension, right heart dilation, and a small left heart due to decreased pulmonary venous return.
Question 5: Which neonatal cardiac finding requires emergent balloon atrial septostomy (Rashkind procedure)?
- Tetralogy of Fallot
- Transposition of the great arteries with intact atrial septum (Correct answer)
- Ventricular septal defect
- Patent ductus arteriosus
Correct answer: Transposition of the great arteries with intact atrial septum
In TGA with an intact atrial septum, blood cannot mix adequately; atrial septostomy creates an atrial communication to allow oxygenated blood to reach the systemic circulation.
Question 6: Dopamine at low doses (2-5 mcg/kg/min) primarily acts on which receptors in neonates?
- Beta-2 adrenergic receptors causing bronchodilation
- Dopaminergic receptors increasing renal and mesenteric perfusion (Correct answer)
- Alpha-1 receptors causing vasoconstriction
- Cholinergic receptors decreasing heart rate
Correct answer: Dopaminergic receptors increasing renal and mesenteric perfusion
Low-dose dopamine primarily stimulates dopaminergic receptors, promoting renal and mesenteric vasodilation, though this effect is less reliable in neonates.
Neonatal Nurse Practitioner Exam Cardiovascular Assessment and Management 2
A neonate with hypoplastic left heart syndrome (HLHS) becomes critically ill when the ductus closes.
The primary reason is: