RNC-NIC Neonatal Cardiovascular Assessment and Care 3

Question 1

Indomethacin is used in premature neonates primarily for which clinical purpose?

Accepted Answer

Pharmacological closure of a hemodynamically significant patent ductus arteriosus

Answer

Treatment of neonatal systemic hypertension

Answer

Management of supraventricular tachycardia

Answer

Prophylaxis against intraventricular hemorrhage in all preterm infants

Question 2

A 28-week preterm neonate develops increasing oxygen requirements, hypotension, bounding pulses, and a systolic murmur consistent with hemodynamically significant PDA. Which is the first-line pharmacological treatment?

Accepted Answer

Indomethacin or ibuprofen to promote ductal closure

Answer

Digoxin to improve cardiac contractility

Answer

Furosemide alone to manage fluid overload

Answer

Dopamine infusion to support blood pressure

Question 3

In a post-cardiac surgery neonate, which combination of findings is most consistent with cardiac tamponade (Beck's triad)?

Accepted Answer

Hypotension, muffled heart sounds, and elevated central venous pressure

Answer

Wide pulse pressure, bounding pulses, and hypertension

Answer

Tachycardia, strong peripheral pulses, and high urine output

Answer

Bradycardia, normal heart sounds, and low CVP

Question 4

A neonate develops supraventricular tachycardia (SVT) with a heart rate of 280 bpm and remains hemodynamically stable. Which intervention should the nurse attempt first?

Accepted Answer

Application of ice to the neonate's face to elicit the diving reflex

Answer

Immediate synchronized cardioversion at 0.5-1 J/kg

Answer

Intravenous adenosine bolus injection

Answer

Oral digoxin loading dose via nasogastric tube

Question 5

A neonate who has undergone the Norwood procedure for HLHS is being monitored postoperatively. What SpO2 range indicates an acceptable balance between pulmonary and systemic blood flow (Qp:Qs ratio of approximately 1:1)?

Accepted Answer

75-85%

Answer

95-100%

Answer

85-90%

Answer

60-70%

Question 6

A postoperative neonate demonstrates signs of low cardiac output including cool mottled extremities, metabolic acidosis (pH 7.20), and urine output less than 0.5 mL/kg/hr. Which medication is most commonly used as first-line inotropic support in neonates?

Accepted Answer

Dopamine to improve cardiac output and renal perfusion

Answer

Norepinephrine to increase systemic vascular resistance

Answer

Epinephrine for immediate cardiac arrest management

Answer

Milrinone as a phosphodiesterase inhibitor

Question 7

Following open-heart surgery, a neonate's chest tube drainage suddenly decreases from 8 mL/hr to 0 mL/hr while the baby becomes tachycardic, hypotensive, and increasingly agitated. What should the nurse suspect and report immediately?

Accepted Answer

Cardiac tamponade from clot obstructing chest tube drainage

Answer

Successful hemostasis indicating the neonate is healing normally

Answer

Expected postoperative fluid shift with improving cardiac function

Answer

Spontaneous extubation requiring immediate reintubation