Pediatric CCRN Exam Pediatric CCRN Neonatal 3 — Questions and Answers
Question 1: A NICU nurse is caring for a neonate with persistent pulmonary hypertension of the newborn (PPHN). The physician orders inhaled nitric oxide (iNO). What is the primary mechanism of action?
- Systemic vasoconstriction to increase afterload
- Selective pulmonary vasodilation (Correct answer)
- Increased cardiac contractility
- Bronchodilation to reduce airway resistance
Correct answer: Selective pulmonary vasodilation
Inhaled nitric oxide causes selective pulmonary vasodilation by stimulating cGMP production in pulmonary vascular smooth muscle without significant systemic effects.
Question 2: A 30-week neonate develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. Bell staging criteria place this neonate at Stage IIB. What intervention is MOST appropriate?
- Surgical resection immediately
- NPO, antibiotics, and abdominal decompression with bowel rest (Correct answer)
- Oral probiotic administration
- Rectal irrigation every 4 hours
Correct answer: NPO, antibiotics, and abdominal decompression with bowel rest
NEC Stage IIB (moderate NEC) is managed medically with NPO status, nasogastric decompression, and broad-spectrum antibiotics for at least 14 days.
Question 3: A neonate born to a mother on methadone maintenance therapy is assessed using the Finnegan Neonatal Abstinence Scoring System. A score of 12 on two consecutive assessments should prompt:
- Continued observation only
- Non-pharmacologic comfort measures only
- Initiation of morphine or methadone pharmacotherapy (Correct answer)
- Immediate transfer to the NICU for intubation
Correct answer: Initiation of morphine or methadone pharmacotherapy
A Finnegan score ≥8 on two consecutive assessments or ≥12 on a single assessment indicates pharmacological treatment is needed for neonatal opioid withdrawal.
Question 4: During a blood transfusion, a neonate develops sudden cardiopulmonary deterioration with hypotension and desaturation. The nurse suspects transfusion-associated circulatory overload (TACO). The FIRST intervention should be:
- Administer epinephrine IV
- Stop the transfusion and notify the physician (Correct answer)
- Increase the transfusion rate to restore volume
- Apply supplemental oxygen only and continue monitoring
Correct answer: Stop the transfusion and notify the physician
The first step in any suspected transfusion reaction, including TACO, is to immediately stop the transfusion and notify the physician for further assessment.
Question 5: A nurse is preparing to insert an umbilical arterial catheter (UAC) in a neonate. Which catheter tip position is considered the HIGH position and is preferred for most neonates?
- T6-T9 (above the diaphragm) (Correct answer)
- L3-L4 (below the renal arteries)
- T10-T12 (at the diaphragm level)
- T1-T4 (above the aortic arch)
Correct answer: T6-T9 (above the diaphragm)
The high UAC position (T6-T9) is above the diaphragm and is preferred as it avoids major branch vessels and reduces complication risks.
Question 6: A neonate at 38 weeks gestation has persistent hypoglycemia despite glucose infusion at 10 mg/kg/min. Which diagnosis should be considered FIRST?
- Transient neonatal hypoglycemia
- Congenital hyperinsulinism (Correct answer)
- Glycogen storage disease type I
- Adrenal insufficiency
Correct answer: Congenital hyperinsulinism
Requirement for glucose infusion rates >8-10 mg/kg/min to maintain normoglycemia strongly suggests congenital hyperinsulinism as the cause.
Question 7: Which of the following is the MOST common cause of unconjugated hyperbilirubinemia in a healthy term neonate on day 3 of life?
- Biliary atresia
- Physiologic jaundice (Correct answer)
- ABO incompatibility hemolytic disease
- Crigler-Najjar syndrome
Correct answer: Physiologic jaundice
Physiologic jaundice peaks on days 3-5 in term neonates due to increased bilirubin production from fetal hemoglobin breakdown and immature hepatic conjugation.
Pediatric CCRN Exam Pediatric CCRN Neonatal 3
A NICU nurse is caring for a neonate with persistent pulmonary hypertension of the newborn (PPHN).
The physician orders inhaled nitric oxide (iNO).
What is the primary mechanism of action?