Neonatal Nurse Practitioner Exam Respiratory Management 1 — Questions and Answers
Question 1: What is the primary goal of surfactant replacement therapy in premature neonates?
- Reduce lung compliance
- Decrease alveolar surface tension to prevent collapse (Correct answer)
- Increase airway resistance
- Promote bronchospasm
Correct answer: Decrease alveolar surface tension to prevent collapse
Surfactant reduces alveolar surface tension, preventing alveolar collapse and improving lung compliance in premature infants.
Question 2: Which ventilator parameter is most directly adjusted to correct hypercapnia in a ventilated neonate?
- FiO2
- PEEP
- Tidal volume or respiratory rate (Correct answer)
- Flow rate
Correct answer: Tidal volume or respiratory rate
Increasing tidal volume or respiratory rate increases minute ventilation, which removes more CO2 and corrects hypercapnia.
Question 3: A term neonate has persistent tachypnea, grunting, and a chest X-ray showing fluid in the fissures. What is the most likely diagnosis?
- Respiratory distress syndrome
- Transient tachypnea of the newborn (Correct answer)
- Meconium aspiration syndrome
- Pneumothorax
Correct answer: Transient tachypnea of the newborn
Transient tachypnea of the newborn (TTN) classically presents with fluid in the interlobar fissures on CXR in term or late-preterm infants.
Question 4: What is the recommended initial FiO2 for resuscitation of a term neonate at birth in the US?
- 100%
- 40%
- 21% (Correct answer)
- 60%
Correct answer: 21%
Current NRP guidelines recommend starting resuscitation of term neonates with room air (21% FiO2) and titrating based on pulse oximetry.
Question 5: Which finding on blood gas is most consistent with respiratory acidosis in a neonate?
- pH 7.50, PaCO2 28 mmHg
- pH 7.20, PaCO2 65 mmHg (Correct answer)
- pH 7.35, PaCO2 40 mmHg
- pH 7.45, PaCO2 38 mmHg
Correct answer: pH 7.20, PaCO2 65 mmHg
Respiratory acidosis is characterized by a low pH combined with elevated PaCO2, reflecting inadequate ventilation.
Question 6: High-frequency oscillatory ventilation (HFOV) is preferred in which neonatal condition?
- Mild TTN
- Pulmonary interstitial emphysema (PIE) (Correct answer)
- Simple apnea of prematurity
- Feeding intolerance
Correct answer: Pulmonary interstitial emphysema (PIE)
HFOV is preferred in PIE because its small tidal volumes and high frequency minimize further barotrauma while maintaining gas exchange.
Neonatal Nurse Practitioner Exam Respiratory Management 1
What is the primary goal of surfactant replacement therapy in premature neonates?