RNC-NIC Congenital Anomalies 2 — Questions and Answers
Question 1: A neonate is born with omphalocele. Which associated anomaly must the nurse prioritize assessing for immediately after birth?
- Congenital heart defects (Correct answer)
- Cleft palate
- Clubfoot
- Hip dysplasia
Correct answer: Congenital heart defects
Omphalocele is strongly associated with cardiac defects, occurring in up to 30-50% of cases, requiring urgent cardiac evaluation.
Question 2: A neonate with gastroschisis is being stabilized. Which intervention is the HIGHEST priority to prevent complications?
- Cover bowel with warm saline-moistened gauze and plastic wrap (Correct answer)
- Administer IV antibiotics immediately
- Place a nasogastric tube to decompress the stomach
- Position the infant in Trendelenburg to improve perfusion
Correct answer: Cover bowel with warm saline-moistened gauze and plastic wrap
Covering the exposed bowel with warm saline gauze and plastic wrap prevents heat and fluid loss, the most immediate life-threatening concerns.
Question 3: Which finding BEST distinguishes gastroschisis from omphalocele on physical examination?
- Gastroschisis has no peritoneal sac covering the herniated organs (Correct answer)
- Omphalocele is always located to the right of the umbilicus
- Gastroschisis is associated with chromosomal anomalies
- Omphalocele involves only intestine, never liver
Correct answer: Gastroschisis has no peritoneal sac covering the herniated organs
Gastroschisis involves herniation of abdominal contents without a peritoneal sac, while omphalocele is covered by a sac.
Question 4: A neonate diagnosed with tracheoesophageal fistula (TEF) type C (EA with distal TEF) is at highest risk for which complication prior to surgical repair?
- Aspiration pneumonia from gastric contents refluxing into the lungs (Correct answer)
- Severe bradycardia from vagal stimulation
- Metabolic alkalosis from excessive secretion loss
- Pulmonary hypertension from airway compression
Correct answer: Aspiration pneumonia from gastric contents refluxing into the lungs
In type C TEF, the distal fistula allows gastric acid to reflux into the lungs, causing aspiration pneumonia if not managed promptly.
Question 5: A nurse caring for a neonate with myelomeningocele notes latex beads in the supply room. What is the priority action?
- Remove all latex products and implement latex-free precautions immediately (Correct answer)
- Notify the surgeon before removing any supplies
- Document the finding and notify the next shift
- Use latex products only for non-invasive procedures
Correct answer: Remove all latex products and implement latex-free precautions immediately
Neonates with myelomeningocele are at high risk for latex allergy sensitization and must have latex-free environments from birth.
Question 6: Which embryologic mechanism explains the development of a diaphragmatic hernia (CDH)?
- Failure of the pleuroperitoneal folds to close completely by 8-10 weeks gestation (Correct answer)
- Abnormal rotation of the midgut loop during the 6th week
- Incomplete fusion of the lateral body folds
- Persistence of the urachus after the second trimester
Correct answer: Failure of the pleuroperitoneal folds to close completely by 8-10 weeks gestation
CDH results from failure of the pleuroperitoneal folds to fuse by 8-10 weeks, allowing abdominal organs to herniate into the chest.
Question 7: A neonate with a known CDH is intubated at birth. Which ventilator strategy is most appropriate to prevent secondary lung injury?
- Permissive hypercapnia with low peak inspiratory pressures (Correct answer)
- Aggressive hyperventilation to reduce pulmonary hypertension
- High-frequency oscillatory ventilation as first-line therapy
- Conventional ventilation targeting PaCO2 of 35-40 mmHg
Correct answer: Permissive hypercapnia with low peak inspiratory pressures
Gentle ventilation with permissive hypercapnia (PaCO2 45-60 mmHg) protects the hypoplastic lungs from barotrauma.
RNC-NIC Congenital Anomalies 2
A neonate is born with omphalocele.
Which associated anomaly must the nurse prioritize assessing for immediately after birth?