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1. Physiologic jaundice is characterized by:
A rise in serum bilirubin to 7.5 mg/100 mls. by the fourth day after birth with a gradual decrease in concentrations of 1.5 mg/100 mls. by the tenth day; increased indirect bilirubin
Visible jaundice before 48 hours of age
Associated ABO incompatability; increased direct bilirubin
A rise in serum bilirubin to 10.5 mg/100 mls. by the second day after birth and a rapid decrease to 2.5 mg/100 mls. by the 8th day.

2. Pathologic jaundice within the first 36 hours of birth may be caused by:
Hemolytic disease, polycythemia, genetic disorders
Polycythemia, hemolytic disease, genetic disorders, prenatal infection
Genetic disorders, hemolytic disease, prenatal infection, post natal infection
Hemolytic disease, biliary artresia, edema

3. Which type of bilirubin is lipid soluble and may cross the blood-brain barrier into the basal ganglia?
Unconjugated
Conjugated
Direct
Indirect

4. Treatment of hyperbilirubinemia may include all of the following except:
Phototherapy
Exchange transfusion
Administration of phenobarbital
Administration of "washed" cells

5. What might be the cause of this jaundice?
Delay in meconium passage
An elevation of serum nonesterified fatty acids
The presence of enzyme inhibitors in the breast milk
Dehydration

6. How might this case be managed?
IV infusion of glucose, phototherapy
Give frequent breast-feedings, 10-12 x per day
Supplementation of breast milk, IV glucose infusion
IV infusion of glucose, exchange transfusion

7. Nursing management of the infant under phototherapy lights includes all the following except:
Accurate recording of intake and output
Keeping infant covered if necessary to maintain stable temperature
Keeping eyes covered
Doing a serum bilirubin level at regular intervals (usually daily)

8. Baby Sara (full-term infant) has a serum bilirubin level of 20 mg/100 ml. The neonatologist orders an exchange transfusion. Throughout the procedure it is essential that metabolic acidosis and cardiac arrest be prevented. Of the following which is most important in preventing these complications?
Observe vital signs every five minutes
Recording blood volume exchanged, amount withdrawn and infused
Closely monitoring body temperature and immediately attending baby's thermo regulation needs
Observe for excessive bleeding at umblical catheter site

9. You expect a medical diagnosis of:
Respiratory distress syndrome
Pneumonia
Hypoglycemia
Fetal alcohol syndrome

10. At 24 hours of age a head sonogram revealed a grade II Intraventricular hemorrhage. What pathophysiology is present?
Rupture of the subependymal veins
Rupture of the subependymal veins, extravasation of the hemorrhage out of the subependymal region
Extravasation of the hemorrhage out of the subependymal region, dilation of the ventricle, death of brain tissue
Blocked ventricle, veins, extravasation of the hemorrhage out of the subependymal region

11. What is the prognosis for this infant?
Resolution of the hemorrhage, or worsening of the hemorrhage
Worsening of the hemorrhage, profound mental and physical handicap
Resolution of the hemorrhage with profound mental, physical handicap
Ventilator dependence

12. Nursing interventions might include all except:
Making the infant NPO until physician notified
Ordering stat abdominal X-rays
Monitoring intake and output
Neurological system assessment of activity level, head circumference; measuring abdominal circumference

13. After careful consideration and further clinical evaluation the physician ordered Baby Wally NPO, a repeat head sonogram, chest and abdominal X-rays, CBC, and blood culture, electrolytes and glucose. Medical diagnoses he may be considering include:
Nectrotizing enterocolitis, sepsis
Perforated ileus
Resolving IVH, Hyperglycemia
Necrotizing enterocolitis, sepsis, resolving IVH, hyperglycemia

14. The most frequent indication for oxygen administration in the newborn is:
Respiratory distress syndrome
Apnea
Cyanosis
Asphyxia

15. Of the following nursing responsibilities in the care of an infant receiving oxygen therapy, which contributes most to prophylaxis of complications?
Carefully recording all data
Vital signs monitored every 30 minutes to 1 hour
Concentration analysis and arterial oxygen tension monitoring
Frequent suctioning of the edotracheal tube with small French catheter

16. Respiratory distress is characterized by all the following except
Tachypnea
Nasal flaring
Grunting; retractions, cyanosis
Seizures

17. Signs and symptoms of respiratory distress may be caused by all of the following except:
Hypothermia
Sepsis
Leukopenia
Seizures

18. Condition characterized by cyanosis, tachypnea, grunting and flaring of the nares often present: sudden change in respiratory status; unequal breath sounds auscultated; shift of apical pulse and chest expansion is assymetrical
Respiratory distress syndrome
Pneumothorax
Bronchopulmonary dysplasia
Apnea

19. Condition in which infant has expiratory grunting or whining when infant is not crying; sternal and intercostal retractions, nasal flaring, cyanosis in room air; chest X-ray shows reticulogranular, ground glass appearance with air bonchograms
Aspiration pneumonia
Status asthmatic
Respiratory Distress Syndrome
Tracheal/Laryngeal Dysplasia

20. Disease caused by prolonged, high, oxygen therapy and mechanical ventilation with a high pressure and an endotracheal tube that disrupts normal mucociliary function, infant usually starts out with respiratory distress syndrome.
Tracheal Esophageal dysplasia
Bronchopulmonary dysplasia
Alveolar fibrosis
Hyaline membrane disease

21. Cessation of breathing for 15-30 seconds; functional changes may occur such as cyanosis, hypotonia, or metabolic acidosis is:
Apnea
Cheyne-Stokes
Respiratory distress syndrome
Functional Apnea

22. Arterial blood gases reflect all the following except:
Pulmonary status of the newborn
Cardiac status of the newborn
Metabolic status of the newborn
Neurological status of the newborn

23. Petechiae and a severely depressed platelet count in an otherwise healthy appearing neonate is most likely due to:
Vitamin K deficiency
Congenital disease of the bone marrow with impairment of platelet production
A transplacentally acquired antibody produced by the mother which attacks the platelets of the infant
Viral infection acquired in utero

24. Other factors which may contribute to vitamin K deficiency include all of the following except:
Antibiotic administration for a prolonged time
Breastfeeding
Malabsorption syndrome
Sepsis

25. Two of the most common organisms causing neonatal septicemia are:
Pseudomonas aeruginosa, E. coli
E. coli, serratia marcescens
E. coli, Group B Beta hemolytic strep
Group B Beta hemolytic strep, pseudomonas aeruginosa

26. Clinical signs and symptoms of sepsis include all but which of the following:
Lethargy
Apnea
Temperature instability
Depressed fontanels

27. Risk factors for neonatal sepsis include all the following except:
Prolonged rupture of amniotic membranes; pronlonged labor
Maternal urinary tract infection, maternal fever
Immersion in warm water just after delivery, as in LeBoyer method
Admission into a special care nursery

28. Which of the following statements is not true concerning neonatal meningitis?
It is the most common infection of the CNS in infants and children
It can be caused by various organisms, including bacteria and viruses, however fungi and parasites are the most common
Generalized sepsis often accompanies meningitis
Requires prompt diagnosis and treament for survival of the infant

29. A baby wet with amniotic fluid loses heat by:
Evaporation
Conduction
Convection
Radiation

30. An uncovered baby in an open crib loses heat by:
Evaporation
Conduction
Convection
Radiation

31. A baby weighed on a cold scale loses heat by:
Evaporation
Conduction
Convection
Radiation

32. A baby in a isolette placed directly under an airconditioning vent loses heat by:
Evaporation
Conduction
Convection
Radiation

33. Clinical signs of hypothermia include all but which one of the following:
Hypotonia
Shallow respirations
Refusal to suck
Increased crying

34. Consequences of hypothermia include:
Hyperglycemia, metabolic acidosis
Metabolic acidosis, hypoglycemia
Pulmonary vasodilation
Depressed production of norepinephrine

35. The neutral thermal environment is one in which
The infant must constantly increase metabolic demands to stay warm
The infant is covered with blankets
The infant maintains a body temperature of 36.5-37 C in an environment in which caloric expenditure and oxygen use is minimal
The infant's body temperature remains constant

36. Infants can maintain their body temperature by all of the following except:
Shivering
Vasoconstriction
Utilizing brown fat
Burning glucose

37. What is the best method for preventing the spreading of infections among neonates?
Maintaining a space of 3 feet around each isolette
Wearing a mask
Strict handwashing
Reading the Infection Control Manual

38. Head circumference may be inaccurate when:
Taken from brow to occiput
Taken from brow to parietal area
Repeated 3 times and averaged
Measuring in inches

39. Bulging, tight fontanelles:
Are normally found in preterm infants
Indicate probable intrauterine growth retardation
Indicate neurological distress
Indicates a large amount of brain tissue

40. Which of these is not a symptom of hypoglycemia?
Restlessness
Weak suck
Passing of meconium stool
Apnea

41. Biochemical resuscitation of the newborn may include all but which of the following:
Sodium bicarbonate 4.2% 1-2mEg IV push
Calcium chloride 0.3cc/kg IV push
Epinephrine 1:10,000 0.1cc/kg IV push
Calcium gluconate 1-2cc/kg IV push

42. Sarah is an infant with a congential cardiac defect. Sarah's mother plans to come for the mid-morning feeding. When planning your teaching strategies for helping Sarah's mom, the best thing to tell her is:
Be persistent, it may take Sarah 45 minutes to 1 hour to eat
Give Sarah a bath first, this will wake her up and get her blood flowing
Feed Sarah small frequent feedings, which last no longer than 20-25 minutes
Wait 4-5 hours between feedings, so Sarah will be really hungry, she will eat a lot better

43. Hypoglycemia in the pre-term infant is indicated by:
Levels below 30-35 mg/100 ml. during the first 72 hours after birth
Levels below 20 mg/100 ml
Levels below 40 mg/100 ml
Levels below 10 mg/100 ml. during first 24 hours after birth

44. The most important steps in any resuscitation include:
Adequate ventilation and oxygenation to correct acidosis
Adequate oxygenation to correct cyanosis, immediate cardiac massage
Immediate cardiac massage and adequate ventilation
Administration of emergency drugs to correct acidosis and prevent serum K levels

45. An undesirable side effect of Theophylline in neonates is:
Low systemic blood pressure
Tachpnea
Tachycardia
Bradycardia

46. Which of the following provides the best method for taking frequent neonate's temperatures?
Rectal temperature
Gluteal fold temperature
Axillary temperature
Forehead temperature

47. Which of the following contributes most to decreasing the incidence of neonatal apnea
Caffeine injections
Auditory stimulation
Tactile stimulation
Suctioning

48. Intermittent gavage feedings are indicated for infants less than 32 weeks gestation. All of the following statements are true concerning gavage feedings except:
The 15 inch size 5 to 8 French feeding tube is secured between feedings to prevent dislodging
The amount of initial feeding is determines by the infant's weight
Stomach contents are aspirated prior to each feeding and residual fluid is recorded and replaced as part of the feeding
Passage of the tube can precipitate changes in heart rate and blood pressure in response to vagal stimulation

49. Which of the following best describes the etiology of enterocolitis?
It is precipitated by invasion of the bowel by Beta hemolytic streptococcus
It often results from inactivity of the bowel during hyperalimentation when the intestinal mucosa undergoes atrophic changes
It results from increased pressure within the intestine following invasion of mucosa with gas forming bacteria
It occurs in infants whose gastrointestinal tract has suffered a vascular compromise related to shunting of blood from the mesentery to a hypoxic vital organ

50. Although definitive diagnosis is established by laboratory and X-ray examination, early subtle signs which indicate possible sepsis in the neonate are:
Vomiting, 100 F
Poor thermoregulation, poor feeding
Jaundice, edema
Tachycardia, pallor