Neonatal Nurse Practitioner for Professional Flashcards

A neonate at 32 weeks corrected age is noted to have absent end-diastolic flow on umbilical artery Doppler. Which management is most appropriate?

Answer: Initiate antenatal corticosteroids and consider delivery timing based on full clinical picture

Absent end-diastolic flow indicates severe uteroplacental insufficiency; management includes steroids for lung maturity and individualized delivery timing.

An infant at 34 weeks gestation has respiratory distress and a chest X-ray showing a ground-glass appearance with air bronchograms. Which surfactant characteristic determines dosing in this scenario?

Answer: Weight-based dosing of 100–200 mg/kg of phospholipid content

Surfactant dosing is standardized by weight using phospholipid content (e.g., beractant 100 mg/kg, poractant alfa 200 mg/kg as initial dose).

Which electrolyte abnormality is most expected in a VLBW infant with a large patent ductus arteriosus (PDA) treated with indomethacin?

Answer: Hyponatremia due to fluid retention

Indomethacin causes renal vasoconstriction, reducing GFR and urine output, which leads to fluid retention and dilutional hyponatremia.

A term infant presents with bilious vomiting on day 2 of life. The most urgent next step is:

Answer: Upper GI series to evaluate for malrotation with midgut volvulus

Bilious vomiting in a neonate must be considered malrotation with midgut volvulus until proven otherwise, as delay can result in catastrophic intestinal loss.

A preterm infant at 26 weeks has a serum potassium of 7.2 mEq/L on day 1 of life with a peaked T wave on EKG. The initial pharmacologic intervention is:

Answer: IV calcium gluconate to stabilize the cardiac membrane

Calcium gluconate is given first in hyperkalemia with EKG changes to immediately stabilize the myocardial membrane and prevent fatal arrhythmia.

Which developmental care strategy has the strongest evidence for improving neurodevelopmental outcomes in preterm infants in the NICU?

Answer: Family integrated care with kangaroo mother care and developmental positioning

Kangaroo care and family-integrated developmental care have robust evidence for improving brain development, reducing stress hormones, and enhancing neurobehavioral outcomes.

A 2-week-old former 28-weeker develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. The antibiotic regimen of choice for confirmed necrotizing enterocolitis is:

Answer: Ampicillin, gentamicin, and metronidazole (or clindamycin)

NEC treatment requires broad-spectrum coverage for gram-positive, gram-negative, and anaerobic organisms with ampicillin, gentamicin, and metronidazole.