Pediatric CCRN Exam Pediatric CCRN Neonatal 2 — Questions and Answers
Question 1: A 28-week premature neonate has a PaCO2 of 28 mmHg on mechanical ventilation. Which complication is most associated with this finding?
- Periventricular leukomalacia (Correct answer)
- Intraventricular hemorrhage
- Retinopathy of prematurity
- Necrotizing enterocolitis
Correct answer: Periventricular leukomalacia
Hypocarbia (low PaCO2) causes cerebral vasoconstriction, reducing blood flow and increasing risk of periventricular leukomalacia in premature neonates.
Question 2: A neonate born at 34 weeks is noted to have a bluish-purple discoloration of the hands and feet with a pink central body. This finding is best described as:
- Central cyanosis
- Acrocyanosis (Correct answer)
- Peripheral vascular disease
- Polycythemia
Correct answer: Acrocyanosis
Acrocyanosis is a normal finding in newborns characterized by blue discoloration of hands and feet with a pink trunk, caused by peripheral vasoconstriction.
Question 3: A neonate with suspected hypoxic-ischemic encephalopathy (HIE) is being evaluated. Which clinical finding would support initiating therapeutic hypothermia?
- Gestational age of 32 weeks
- Apgar score of 7 at 5 minutes
- Cord blood pH of 6.98 with base deficit of -14 (Correct answer)
- Onset of seizures 24 hours after birth
Correct answer: Cord blood pH of 6.98 with base deficit of -14
Therapeutic hypothermia criteria include cord blood pH ≤7.0 or base deficit ≥16, or pH 7.01-7.15 with base deficit 10-15.9 plus additional clinical criteria.
Question 4: A term neonate is started on prostaglandin E1 (PGE1) for a suspected ductal-dependent cardiac lesion. Which side effect requires the MOST immediate intervention?
- Fever
- Apnea (Correct answer)
- Flushing
- Hypotension
Correct answer: Apnea
Apnea is the most life-threatening side effect of PGE1 and requires immediate airway management and may necessitate intubation.
Question 5: When calculating total fluid requirements for a neonate on day 1 of life weighing 1.2 kg, which factor most significantly increases insensible water losses?
- Use of radiant warmer (Correct answer)
- Closed incubator
- Humidified oxygen
- Phototherapy for mild jaundice
Correct answer: Use of radiant warmer
Radiant warmers significantly increase insensible water losses (up to 50-100%) compared to closed incubators, requiring adjustment in fluid calculations.
Question 6: A 26-week neonate receiving surfactant therapy exhibits a sudden drop in oxygen requirement from FiO2 0.60 to 0.35 following administration. The MOST important next nursing action is:
- Increase PEEP by 2 cmH2O
- Notify the physician of improvement
- Wean ventilator settings to avoid hyperoxia (Correct answer)
- Obtain arterial blood gas in 4 hours
Correct answer: Wean ventilator settings to avoid hyperoxia
Rapid improvement in oxygenation after surfactant requires immediate ventilator weaning to prevent oxygen toxicity and volutrauma.
Question 7: A neonate with suspected meningitis has a lumbar puncture performed. Which CSF finding is MOST consistent with bacterial meningitis in a neonate?
- Glucose 40 mg/dL, protein 60 mg/dL, WBC 5 cells/mm3
- Glucose 20 mg/dL, protein 180 mg/dL, WBC 450 cells/mm3 (Correct answer)
- Glucose 50 mg/dL, protein 90 mg/dL, WBC 15 cells/mm3
- Glucose 35 mg/dL, protein 40 mg/dL, WBC 8 cells/mm3
Correct answer: Glucose 20 mg/dL, protein 180 mg/dL, WBC 450 cells/mm3
Bacterial meningitis typically presents with low CSF glucose, elevated protein, and markedly elevated WBC with neutrophil predominance.
Pediatric CCRN Exam Pediatric CCRN Neonatal 2
A 28-week premature neonate has a PaCO2 of 28 mmHg on mechanical ventilation.
Which complication is most associated with this finding?