Neonatal Nurse Practitioner for Professional Flashcards

A 30-week infant on mechanical ventilation develops sudden deterioration with decreased breath sounds on the left and shift of the cardiac impulse to the right. The priority intervention is:

Answer: Emergent needle thoracentesis at the second intercostal space midclavicular line

Sudden deterioration with unilateral decreased breath sounds and cardiac shift indicates tension pneumothorax requiring immediate needle decompression.

When initiating total parenteral nutrition (TPN) in a VLBW infant, which amino acid intake on day 1 best supports positive nitrogen balance?

Answer: 3.5 g/kg/day

Early aggressive amino acid intake of 3–4 g/kg/day from day 1 promotes positive nitrogen balance and reduces catabolism in VLBW infants.

A term infant is diagnosed with persistent pulmonary hypertension (PPHN). After failing to respond to 100% oxygen, which pharmacologic agent is the first-line treatment?

Answer: Inhaled nitric oxide (iNO)

Inhaled nitric oxide is the first-line selective pulmonary vasodilator approved for PPHN in term and near-term infants.

A preterm infant receiving gentamicin for sepsis has a trough level of 2.8 mcg/mL (goal <1 mcg/mL). Which action is most appropriate?

Answer: Extend the dosing interval and recheck trough before next dose

Elevated trough gentamicin levels indicate accumulation and nephrotoxicity/ototoxicity risk, requiring interval extension until trough normalizes.

Which of the following best describes the mechanism by which hypothermia therapy reduces brain injury after hypoxic-ischemic encephalopathy (HIE)?

Answer: Suppresses glutamate-mediated excitotoxicity and apoptotic cascades in the latent phase

Cooling interrupts the secondary energy failure phase by suppressing glutamate release, apoptotic signaling, and free radical production.

A neonate born to a mother with poorly controlled type 1 diabetes has a hematocrit of 72% at 4 hours of life. The infant is asymptomatic. The most appropriate management is:

Answer: Partial exchange transfusion with normal saline

Symptomatic polycythemia or a hematocrit ≥65-70% with risk factors warrants partial exchange transfusion to reduce hyperviscosity.

A family requests withdrawal of life-sustaining treatment for their 24-week infant after 3 weeks of maximal support with ongoing deterioration. The NNP's ethical priority is to:

Answer: Facilitate a family meeting with the palliative care team to align goals of care with family values

Family-centered palliative care meetings are the ethical standard to ensure informed, values-based decision-making when redirecting care for critically ill neonates.