Neonatal Nurse Practitioner Exam Pharmacology and Medications 2 — Questions and Answers
Question 1: Why is erythromycin eye ointment applied to neonates at birth in the US?
- Prevention of herpes simplex ophthalmia
- Prophylaxis against Neisseria gonorrhoeae ophthalmia neonatorum (Correct answer)
- Treatment of chlamydial conjunctivitis
- Prevention of bacterial endophthalmitis
Correct answer: Prophylaxis against Neisseria gonorrhoeae ophthalmia neonatorum
Erythromycin ointment is applied prophylactically to prevent gonococcal ophthalmia neonatorum, which can cause blindness if untreated.
Question 2: A neonate develops hypoglycemia despite feeding. Diazoxide is started. What is its mechanism of action?
- Stimulates insulin secretion from pancreatic beta cells
- Inhibits insulin secretion by opening ATP-sensitive potassium channels (Correct answer)
- Increases glucagon release
- Blocks gluconeogenesis
Correct answer: Inhibits insulin secretion by opening ATP-sensitive potassium channels
Diazoxide opens K-ATP channels in pancreatic beta cells, hyperpolarizing the membrane and inhibiting insulin secretion to treat hyperinsulinemic hypoglycemia.
Question 3: What is the most important pharmacokinetic difference in neonates compared to adults when dosing medications?
- Faster hepatic metabolism
- Larger volume of distribution, lower protein binding, and immature renal/hepatic clearance (Correct answer)
- Smaller volume of distribution and rapid renal clearance
- Higher albumin concentrations
Correct answer: Larger volume of distribution, lower protein binding, and immature renal/hepatic clearance
Neonates have higher body water content (larger Vd), lower protein binding (more free drug), and immature organ clearance, requiring dose and interval adjustments.
Question 4: Morphine is used for analgesia/sedation in ventilated neonates. Which adverse effect requires the most monitoring?
- Hypertension
- Respiratory depression and hypotension (Correct answer)
- Hyperglycemia
- Increased bowel motility
Correct answer: Respiratory depression and hypotension
Morphine causes dose-dependent respiratory depression and hypotension in neonates, requiring careful monitoring of respiratory rate and blood pressure.
Question 5: What is the recommended dose of epinephrine for neonatal cardiac resuscitation via endotracheal tube per NRP guidelines?
- 0.01-0.03 mg/kg IV
- 0.05-0.1 mg/kg ET (Correct answer)
- 0.5 mg/kg IV
- 0.001 mg/kg IV
Correct answer: 0.05-0.1 mg/kg ET
When IV access is unavailable, NRP recommends 0.05-0.1 mg/kg epinephrine via ET tube, though IV/IO administration is preferred for reliability.
Question 6: Furosemide is used in neonates with fluid overload. What electrolyte abnormality must be monitored closely?
- Hyperkalemia
- Hypokalemia and hypocalcemia (Correct answer)
- Hypernatremia
- Hyperphosphatemia
Correct answer: Hypokalemia and hypocalcemia
Furosemide causes renal loss of potassium and calcium, predisposing neonates to hypokalemia, hypocalcemia, and nephrocalcinosis with prolonged use.
Neonatal Nurse Practitioner Exam Pharmacology and Medications 2
Why is erythromycin eye ointment applied to neonates at birth in the US?