Pediatric CCRN Exam Pediatric CCRN Neonatal 4

Question 1

A premature neonate (27 weeks) requires total parenteral nutrition (TPN). Which complication is MOST associated with long-term TPN use in neonates?

Accepted Answer

TPN-associated cholestasis

Answer

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:

Accepted Answer

Left-sided congenital diaphragmatic hernia (CDH)

Answer

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?

Accepted Answer

Bulging fontanelle and increasing head circumference

Answer

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?

Accepted Answer

Bronze skin discoloration in a neonate with direct hyperbilirubinemia

Answer

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:

Accepted Answer

Intubate, administer surfactant, and extubate back to CPAP

Answer

The INSURE technique (INtubate-SURfactant-Extubate) involves brief intubation for surfactant delivery followed by rapid extubation to non-invasive respiratory support.

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Pediatric CCRN Neonatal 4