NPS NPS Family-Centered Care and Ethics 2 — Questions and Answers
Question 1: According to the AAP guidelines, at what gestational age is resuscitation at birth generally considered optional based on parental preference?
- 20–21 weeks
- 22–23 weeks (Correct answer)
- 24–25 weeks
- 26–28 weeks
Correct 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.
Question 2: A breastfeeding mother of a NICU infant is struggling with milk supply. Which intervention has the strongest evidence for increasing supply?
- Formula supplementation to reduce demand on the mother
- Frequent pumping (8+ times per day) combined with skin-to-skin contact (Correct answer)
- Domperidone as first-line pharmacologic therapy
- Restricting fluid intake to concentrate milk
Correct answer: Frequent pumping (8+ times per day) combined with skin-to-skin contact
Frequent pumping mimicking an infant's feeding pattern (8 or more times per day), combined with kangaroo care, is the most effective evidence-based strategy for establishing and maintaining milk supply.
Question 3: What is the primary purpose of developmental care practices such as NIDCAP (Newborn Individualized Developmental Care and Assessment Program)?
- To standardize care protocols across all NICU nurses
- To individualize care based on each neonate's behavioral cues to reduce stress and support neurodevelopment (Correct answer)
- To eliminate parental involvement during acute illness phases
- To quantify nursing workload for staffing decisions
Correct answer: To individualize care based on each neonate's behavioral cues to reduce stress and support neurodevelopment
NIDCAP uses systematic observation of behavioral cues to tailor care timing, positioning, and environmental stimulation to each neonate's neurodevelopmental tolerance.
Question 4: Which ethical obligation requires healthcare providers to disclose all relevant information to parents so they can make informed decisions for their neonate?
- Beneficence
- Justice
- Informed consent (Correct answer)
- Confidentiality
Correct 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.
Question 5: A 34-week neonate is ready for discharge. Which parenting education topic is MOST critical before discharge home?
- Introduction to solid foods at 6 months
- Safe sleep practices (supine positioning, firm flat surface, no co-sleeping) (Correct answer)
- Starting vitamin D supplementation at 2 years
- Immunization schedule for 9-month visit
Correct answer: Safe sleep practices (supine positioning, firm flat surface, no co-sleeping)
Safe sleep education (back to sleep, firm surface, room-sharing without bed-sharing) is critical before NICU discharge to reduce the risk of sudden infant death syndrome (SIDS).
Question 6: Which approach best describes the standard for surrogate decision-making for neonates?
- Physician determines best interest without parental input
- Best interest standard — parents decide what is in the neonate's best interest (Correct answer)
- Substituted judgment — what would the neonate choose if they could speak
- Legal guardian is always appointed by the court for neonates
Correct answer: Best interest standard — parents decide what is in the neonate's best interest
Neonatal decision-making uses the 'best interest standard' where parents, guided by medical teams, determine what course of action would best serve the neonate's welfare.
NPS NPS Family-Centered Care and Ethics 2
According to the AAP guidelines, at what gestational age is resuscitation at birth generally considered optional based on parental preference?