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

Indomethacin is a prostaglandin synthetase inhibitor (COX inhibitor) that reduces prostaglandin E2 levels, promoting ductal smooth muscle constriction and closure of the PDA.

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

COX inhibitors such as indomethacin or ibuprofen are first-line pharmacological agents for hemodynamically significant PDA in preterm neonates when there are no contraindications.

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

Cardiac tamponade is identified by Beck's triad: hypotension from reduced cardiac output, muffled heart sounds from pericardial fluid, and elevated venous pressure from impaired right heart filling.

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

In stable neonatal SVT, vagal maneuvers such as applying ice to the face (eliciting the diving/oculocardiac reflex) are attempted first before pharmacological cardioversion with adenosine.

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

After the Norwood procedure, SpO2 of 75-85% reflects a balanced Qp:Qs ratio near 1:1; higher saturations indicate excessive pulmonary blood flow stealing from the systemic circulation.

Neonatal Intensive Care Nurse Exam Practice Test

Neonatal Intensive Care Nurse Exam Practice Test

RNC-NIC Neonatal Cardiovascular Assessment and Care 3