Neonatal Nurse Practitioner Exam Pharmacology and Medications 1 — Questions and Answers
Question 1: Which antibiotic combination is the standard empiric therapy for early-onset neonatal sepsis in the US?
- Vancomycin and gentamicin
- Ampicillin and gentamicin (Correct answer)
- Cefotaxime and metronidazole
- Piperacillin-tazobactam and clindamycin
Correct answer: Ampicillin and gentamicin
Ampicillin and gentamicin provide coverage for the most common early-onset sepsis pathogens (GBS and gram-negative organisms including Listeria).
Question 2: What is the primary risk associated with chloramphenicol use in neonates?
- Kernicterus
- Gray baby syndrome due to immature hepatic metabolism (Correct answer)
- Ototoxicity
- Nephrotoxicity
Correct answer: Gray baby syndrome due to immature hepatic metabolism
Gray baby syndrome occurs because neonates lack adequate hepatic glucuronyl transferase to metabolize chloramphenicol, leading to toxic accumulation causing cardiovascular collapse.
Question 3: Vitamin K is routinely administered to neonates at birth to prevent:
- Hemolytic disease of the newborn
- Hemorrhagic disease of the newborn (HDN) (Correct answer)
- Sepsis
- Hyperbilirubinemia
Correct answer: Hemorrhagic disease of the newborn (HDN)
Neonates have low vitamin K stores and lack gut flora to produce it, predisposing them to bleeding; prophylactic vitamin K prevents HDN.
Question 4: A neonate has an arterial blood gas showing pH 7.15, PaCO2 40, HCO3 14. What drug treatment addresses the underlying metabolic cause?
- Sodium bicarbonate (cautiously for severe metabolic acidosis) (Correct answer)
- Dexamethasone
- Furosemide
- Caffeine
Correct answer: Sodium bicarbonate (cautiously for severe metabolic acidosis)
Sodium bicarbonate may be used cautiously for severe, documented metabolic acidosis after ensuring adequate ventilation, as CO2 is normal in this case.
Question 5: Which medication requires careful monitoring of serum drug levels due to its narrow therapeutic index in neonates?
- Vitamin D
- Vancomycin (Correct answer)
- Folic acid
- Iron supplementation
Correct answer: Vancomycin
Vancomycin has a narrow therapeutic index and variable pharmacokinetics in neonates; levels must be monitored to avoid nephrotoxicity and ensure efficacy.
Question 6: Phenobarbital is used in neonatal seizures. What is an important side effect to monitor?
- Hyperglycemia
- Respiratory depression, sedation, and hypotension (Correct answer)
- Tachycardia
- Hyperthermia
Correct answer: Respiratory depression, sedation, and hypotension
Phenobarbital can cause respiratory depression, sedation, and hypotension in neonates, requiring close monitoring of vital signs and respiratory status.
Neonatal Nurse Practitioner Exam Pharmacology and Medications 1
Which antibiotic combination is the standard empiric therapy for early-onset neonatal sepsis in the US?