Neonatal Nurse Practitioner for Professional Flashcards

A preterm infant at 28 weeks gestation presents with apnea of prematurity. Which mechanism best explains this condition?

Answer: Immature respiratory center with decreased response to CO2

Apnea of prematurity results from an immature brainstem respiratory center with blunted chemoreceptor response to CO2.

When calculating maintenance IV fluid requirements for a VLBW infant on day of life 1, which factor most significantly increases insensible water losses?

Answer: Phototherapy and radiant warmer use

Radiant warmers and phototherapy significantly increase insensible water losses through evaporation and radiation, sometimes doubling baseline requirements.

A term neonate has a serum bilirubin of 22 mg/dL at 48 hours of life. Direct Coombs test is positive. Which condition is most likely?

Answer: ABO incompatibility

A positive direct Coombs test indicates maternal antibodies coating neonatal red blood cells, most commonly due to ABO incompatibility.

A neonate born at 36 weeks develops hypoglycemia. After three 15-minute dextrose gel treatments fail to normalize glucose, the next best step is:

Answer: Initiate IV dextrose infusion at 4-6 mg/kg/min

IV dextrose infusion is indicated when oral/buccal dextrose gel fails to correct persistent hypoglycemia in a neonate.

Which finding on cranial ultrasound in a preterm infant indicates the highest risk for long-term neurodevelopmental impairment?

Answer: Grade IV IVH with periventricular hemorrhagic infarction

Grade IV IVH with periventricular hemorrhagic infarction (PVHI) carries the highest risk of cerebral palsy and severe cognitive impairment.

A 3-day-old term infant presents with temperature instability, poor feeding, and a WBC of 3,200 cells/µL with an I:T ratio of 0.28. Which diagnosis should be treated empirically?

Answer: Early-onset neonatal sepsis

An elevated immature-to-total neutrophil ratio (>0.2) combined with clinical signs warrants empiric antibiotic treatment for early-onset sepsis.

During a difficult resuscitation, the team leader notices escalating tension. Which communication technique best maintains team performance?

Answer: Closed-loop communication with role clarity and directed task assignment

Closed-loop communication with clear role assignments prevents errors of omission and maintains situational awareness during high-stress neonatal resuscitation.