Pediatric CCRN Exam Pediatric CCRN Neonatal 4 — Questions and Answers
Question 1: A premature neonate (27 weeks) requires total parenteral nutrition (TPN). Which complication is MOST associated with long-term TPN use in neonates?
- Hypernatremia
- TPN-associated cholestasis (Correct answer)
- Respiratory alkalosis
- Hypercalcemia
Correct answer: TPN-associated cholestasis
TPN-associated cholestasis (PNAC/IFALD) is a significant complication of prolonged TPN use in neonates, presenting with elevated conjugated bilirubin.
Question 2: A term neonate presents with respiratory distress, decreased breath sounds on the left, and heart sounds shifted to the right. The MOST likely diagnosis is:
- Right-sided pneumothorax
- Left-sided congenital diaphragmatic hernia (CDH) (Correct answer)
- Transient tachypnea of the newborn
- Meconium aspiration syndrome
Correct answer: Left-sided congenital diaphragmatic hernia (CDH)
CDH typically presents with respiratory distress, absent breath sounds ipsilateral to the defect, and contralateral mediastinal shift due to herniated abdominal contents.
Question 3: A neonate with a Grade III intraventricular hemorrhage (IVH) is being monitored. Which clinical sign would MOST indicate developing post-hemorrhagic hydrocephalus?
- Decreasing head circumference
- Bulging fontanelle and increasing head circumference (Correct answer)
- Improved feeding tolerance
- Resolution of apnea episodes
Correct answer: Bulging fontanelle and increasing head circumference
Post-hemorrhagic hydrocephalus manifests as increasing head circumference, bulging fontanelle, dilated scalp veins, and setting-sun sign due to CSF accumulation.
Question 4: A nurse is caring for a neonate receiving phototherapy for hyperbilirubinemia. Which assessment finding warrants IMMEDIATE discontinuation and physician notification?
- Loose green stools
- Bronze skin discoloration in a neonate with direct hyperbilirubinemia (Correct answer)
- Increased insensible water losses
- Mild macular rash
Correct answer: Bronze skin discoloration in a neonate with direct hyperbilirubinemia
Bronze baby syndrome occurs when phototherapy is given to neonates with direct (conjugated) hyperbilirubinemia, which is a contraindication to phototherapy.
Question 5: A 32-week neonate on CPAP therapy has increased work of breathing, SpO2 of 88%, and FiO2 requirement increasing to 0.45. According to the INSURE technique, the NEXT step is:
- Continue CPAP and increase PEEP to 8 cmH2O
- Intubate, administer surfactant, and extubate back to CPAP (Correct answer)
- Switch to high-frequency oscillatory ventilation immediately
- Administer IV caffeine and reassess in 2 hours
Correct answer: Intubate, administer surfactant, and extubate back to CPAP
The INSURE technique (INtubate-SURfactant-Extubate) involves brief intubation for surfactant delivery followed by rapid extubation to non-invasive respiratory support.
Question 6: A neonate born at 36 weeks presents with hypocalcemia on day 1. Which maternal condition is MOST likely responsible for this early-onset neonatal hypocalcemia?
- Maternal hypothyroidism
- Maternal hyperparathyroidism (Correct answer)
- Maternal diabetes mellitus
- Maternal vitamin D toxicity
Correct answer: Maternal hyperparathyroidism
Maternal hyperparathyroidism causes fetal hypercalcemia, suppressing fetal parathyroid gland development, leading to early hypocalcemia after birth when maternal calcium supply is removed.
Question 7: A nurse is assessing a neonate for retinopathy of prematurity (ROP) screening eligibility. Which criteria CORRECTLY identifies who requires screening?
- All neonates born before 37 weeks gestation
- Neonates born at ≤30 weeks gestation OR birth weight ≤1500g (Correct answer)
- Only neonates who received supplemental oxygen >5 days
- Neonates born at <34 weeks gestation regardless of weight
Correct answer: Neonates born at ≤30 weeks gestation OR birth weight ≤1500g
AAP guidelines recommend ROP screening for neonates born at ≤30 weeks gestation or with birth weight ≤1500g, as well as selected infants 31-36 weeks with unstable clinical course.
Pediatric CCRN Exam Pediatric CCRN Neonatal 4
A premature neonate (27 weeks) requires total parenteral nutrition (TPN).
Which complication is MOST associated with long-term TPN use in neonates?