Neonatal Nurse Practitioner Exam Respiratory Management 2 — Questions and Answers
Question 1: Which condition is characterized by a persistent right-to-left shunt through the ductus arteriosus and foramen ovale in a term neonate?
- Respiratory distress syndrome
- Persistent pulmonary hypertension of the newborn (PPHN) (Correct answer)
- Bronchopulmonary dysplasia
- Apnea of prematurity
Correct answer: Persistent pulmonary hypertension of the newborn (PPHN)
PPHN involves elevated pulmonary vascular resistance causing right-to-left shunting through fetal channels, bypassing the lungs.
Question 2: Inhaled nitric oxide (iNO) is used in neonates primarily to:
- Increase systemic blood pressure
- Selectively dilate pulmonary vasculature (Correct answer)
- Decrease cardiac output
- Treat bronchopulmonary dysplasia directly
Correct answer: Selectively dilate pulmonary vasculature
iNO selectively dilates pulmonary vasculature without systemic effects, reducing pulmonary hypertension and improving oxygenation.
Question 3: A preterm infant on CPAP has a sudden desaturation with decreased breath sounds on the right. What is the priority action?
- Increase FiO2
- Obtain chest X-ray and prepare for needle decompression (Correct answer)
- Administer surfactant
- Increase CPAP pressure
Correct answer: Obtain chest X-ray and prepare for needle decompression
Sudden unilateral desaturation with absent breath sounds suggests pneumothorax, requiring urgent chest X-ray and possible needle decompression.
Question 4: Which drug is first-line for pharmacologic treatment of apnea of prematurity?
- Doxapram
- Caffeine citrate (Correct answer)
- Theophylline
- Aminophylline
Correct answer: Caffeine citrate
Caffeine citrate is the preferred first-line methylxanthine for apnea of prematurity due to its superior safety profile and once-daily dosing.
Question 5: What does a pre-ductal SpO2 greater than post-ductal SpO2 by more than 10% indicate in a neonate?
- Patent ductus arteriosus with left-to-right shunt
- Right-to-left ductal shunting consistent with PPHN (Correct answer)
- Normal transitional circulation
- Peripheral vascular disease
Correct answer: Right-to-left ductal shunting consistent with PPHN
A significant pre-to-post-ductal SpO2 gradient indicates right-to-left shunting through the ductus arteriosus, consistent with PPHN.
Question 6: Bronchopulmonary dysplasia (BPD) in a premature infant is defined by the need for supplemental oxygen at:
- 7 days of life
- 28 days of life or 36 weeks postmenstrual age (Correct answer)
- 14 days of life
- Term corrected age only
Correct answer: 28 days of life or 36 weeks postmenstrual age
BPD is defined as oxygen requirement at 28 days of life or at 36 weeks postmenstrual age, reflecting chronic lung disease of prematurity.
Neonatal Nurse Practitioner Exam Respiratory Management 2
Which condition is characterized by a persistent right-to-left shunt through the ductus arteriosus and foramen ovale in a term neonate?