NNP Neonatal Nurse Practitioner for Professional 4 — Questions and Answers
Question 1: A neonate at 32 weeks corrected age is noted to have absent end-diastolic flow on umbilical artery Doppler. Which management is most appropriate?
- Initiate antenatal corticosteroids and consider delivery timing based on full clinical picture (Correct answer)
- Immediate cesarean delivery regardless of fetal status
- Increase maternal IV fluid rate and reassess in 24 hours
- Begin oral nifedipine for maternal blood pressure management
Correct 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.
Question 2: 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?
- Weight-based dosing of 100–200 mg/kg of phospholipid content (Correct answer)
- Fixed dose of 3 mL regardless of weight
- Dosing based on gestational age alone
- Dose determined by FiO2 requirement at time of administration
Correct 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).
Question 3: Which electrolyte abnormality is most expected in a VLBW infant with a large patent ductus arteriosus (PDA) treated with indomethacin?
- Hyponatremia due to fluid retention (Correct answer)
- Hyperkalemia due to cell lysis
- Hypercalcemia due to bone resorption
- Hypernatremia due to free water loss
Correct answer: Hyponatremia due to fluid retention
Indomethacin causes renal vasoconstriction, reducing GFR and urine output, which leads to fluid retention and dilutional hyponatremia.
Question 4: A term infant presents with bilious vomiting on day 2 of life. The most urgent next step is:
- Upper GI series to evaluate for malrotation with midgut volvulus (Correct answer)
- Abdominal ultrasound to assess for pyloric stenosis
- Trial of feeding thickener and positional management
- Rectal biopsy to rule out Hirschsprung disease
Correct 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.
Question 5: 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:
- IV calcium gluconate to stabilize the cardiac membrane (Correct answer)
- Kayexalate retention enema
- IV sodium bicarbonate only
- Furosemide to promote renal potassium excretion
Correct 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.
Question 6: Which developmental care strategy has the strongest evidence for improving neurodevelopmental outcomes in preterm infants in the NICU?
- Family integrated care with kangaroo mother care and developmental positioning (Correct answer)
- Strict 4-hour clustered care with total sensory isolation between cares
- Continuous background white noise to simulate intrauterine environment
- Limiting parental visitation to reduce infection risk
Correct 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.
Question 7: 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:
- Ampicillin, gentamicin, and metronidazole (or clindamycin) (Correct answer)
- Vancomycin and piperacillin-tazobactam alone
- Oral metronidazole only
- Ceftriaxone and azithromycin
Correct 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.
NNP Neonatal Nurse Practitioner for Professional 4
A neonate at 32 weeks corrected age is noted to have absent end-diastolic flow on umbilical artery Doppler.
Which management is most appropriate?