Mixed Deck — All NPS Topics Flashcards

A preterm neonate on total parenteral nutrition develops cholestatic jaundice. Which TPN component is most likely responsible?

Answer: Lipid emulsion (IVFE)

Intravenous fat emulsions (IVFE), particularly phytosterol-containing soybean-based lipids, are strongly associated with parenteral nutrition-associated liver disease in neonates.

What tidal volume range is recommended for lung-protective ventilation in ventilated neonates?

Answer: 4–6 mL/kg

A tidal volume of 4–6 mL/kg is recommended for neonatal lung-protective ventilation to minimize volutrauma while maintaining adequate CO2 clearance.

A term neonate has a 5-minute Apgar score of 2. Which therapeutic intervention, if initiated within 6 hours, improves neurological outcomes?

Answer: Therapeutic hypothermia at 33–34°C for 72 hours

Therapeutic hypothermia (whole-body cooling to 33–34°C for 72 hours) initiated within 6 hours of birth is the standard of care for moderate-severe HIE.

During neonatal resuscitation, the initial FiO2 for a term newborn should be:

Answer: 21% (room air)

Current NRP guidelines recommend starting resuscitation of term newborns with room air (21% O2), titrating upward based on pulse oximetry.

A term neonate presents with tachypnea, mild hypoxia, and a chest X-ray showing fluid in the horizontal fissure and perihilar streaking. What is the most likely diagnosis?

Answer: Transient tachypnea of the newborn (TTN)

TTN results from delayed resorption of fetal lung fluid and presents with tachypnea and perihilar streaking/fissure fluid on CXR, typically resolving within 24–72 hours.

A nurse reports that a colleague failed to wash hands before touching a NICU patient. What ethical principle requires the reporting nurse to speak up?

Answer: Beneficence and non-maleficence

Beneficence (duty to benefit the patient) and non-maleficence (duty to avoid harm) require healthcare providers to report unsafe practices that could cause patient harm.

A 28-week neonate receives vancomycin for suspected sepsis. Which pharmacokinetic parameter is most commonly monitored to guide dosing?

Answer: AUC/MIC ratio

AUC/MIC-guided vancomycin monitoring (targeting AUC 400–600) is now preferred over trough-only monitoring in neonates and pediatric patients.

According to the AAP guidelines, at what gestational age is resuscitation at birth generally considered optional based on parental preference?

Answer: 22–23 weeks

The AAP considers 22–23 weeks a 'gray zone' where resuscitation is ethically optional; at 22 weeks, survival is rare and morbidity near-universal, making parental choice central.

Which ethical obligation requires healthcare providers to disclose all relevant information to parents so they can make informed decisions for their neonate?

Answer: Informed consent

Informed consent requires that providers disclose diagnosis, prognosis, treatment options, risks, and benefits in understandable language so parents can make voluntary, autonomous decisions.

A neonate born at 26 weeks gestation has a brain ultrasound showing blood in the lateral ventricles without dilation. This is classified as which grade of IVH?

Answer: Grade II

Grade II IVH (Papile classification) involves blood within the ventricles without ventricular dilation, indicating bleeding into the ventricular system from the germinal matrix.

Which surfactant is administered intratracheally as a natural bovine-derived preparation for neonatal RDS?

Answer: All of the above

Beractant, calfactant, and poractant alfa are all natural animal-derived surfactants approved for intratracheal administration in neonatal RDS.

What is the correct energy dose for the FIRST defibrillation attempt in a pediatric patient with ventricular fibrillation?

Answer: 2 J/kg

PALS recommends an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT, with subsequent shocks at 4 J/kg.

Which intervention is most effective in preventing catheter-associated urinary tract infections (CAUTI) in neonates?

Answer: Removing urinary catheters as soon as they are no longer clinically necessary

Duration of catheterization is the strongest independent risk factor for CAUTI; timely removal when the catheter is no longer clinically indicated is the most effective prevention strategy.

What is the most common route of transmission for healthcare-associated infections in the neonatal intensive care unit (NICU)?

Answer: Contact transmission via contaminated healthcare worker hands

Contact transmission via contaminated healthcare worker hands is the predominant route of HAI spread in the NICU, making hand hygiene the single most important prevention measure.

When administering prostaglandin E1 (alprostadil) to a neonate with ductal-dependent congenital heart disease, which adverse effect requires immediate readiness?

Answer: Apnea

Apnea is the most critical adverse effect of prostaglandin E1 infusion in neonates, requiring intubation readiness at the bedside.

During neonatal transport, a 27-week premature neonate becomes increasingly tachycardic and pale. Blood glucose is 22 mg/dL. What is the first intervention?

Answer: IV dextrose 10% at 2 mL/kg bolus

Symptomatic hypoglycemia in a neonate is treated with a D10W minibolus of 2 mL/kg IV, providing approximately 200 mg/kg glucose to rapidly restore euglycemia.

What is the initial fluid bolus volume and type for a pediatric patient in septic shock?

Answer: 20 mL/kg isotonic crystalloid

Current PALS guidelines recommend 20 mL/kg isotonic crystalloid (normal saline or LR) as the initial fluid bolus for pediatric septic shock, reassessing after each bolus.

During neonatal resuscitation, chest compressions are indicated when the heart rate remains below what threshold after 30 seconds of effective positive pressure ventilation?

Answer: 60 bpm

NRP guidelines specify initiating chest compressions when HR remains <60 bpm after 30 seconds of effective PPV with 100% oxygen.

A neonate develops a sudden deterioration on mechanical ventilation. The NPS performs a DOPE assessment. What does 'D' stand for?

Answer: Displacement of the ETT

The DOPE mnemonic for sudden deterioration on a ventilator stands for Displacement, Obstruction, Pneumothorax, and Equipment failure.

Which opiate analgesic is MOST commonly used for procedural pain management in neonates due to its predictable pharmacokinetics?

Answer: Fentanyl

Fentanyl is preferred for neonatal procedural pain due to its rapid onset, short duration, minimal histamine release, and predictable pharmacokinetics.