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Lesson 1: Overview and Principles of Resuscitation Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 A full-term newborn is apneic after birth and fails to respond to tactile stimulation. Newborns in secondary apnea usually respond with an increase in heart rate after which intervention? Answers istration of free-flow 100% oxygen Increasingly vigorous tactile stimulation Chest compressions at a rate of 30 per minute Effective positive-pressure ventilation Next Question 2 of 12 A caregiver states that he can always predict which babies will need help at birth. You disagree because you know that ____% of newborns require initial assessment to determine whether resuscitation is required. Answers 10% 1% 50% 100% PreviousNext Question 3 of 12 After the initial steps in resuscitation, a newborn is apneic with a heart rate less than 100 beats per minute. What is the most important and effective action to take in the resuscitation of this baby? Answers Provide supplemental oxygen. Ventilate the lungs. Give epinephrine. Perform chest compressions. PreviousNext Question 4 of 12 A newborn requires resuscitation, and you have begun positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions and the need to continue some aspect of ? Answers Respirations, heart rate, assessment of oxygenation Blood pressure, assessment of oxygenation, heart rate Respirations, blood pressure, assessment of oxygenation Respirations, muscle tone, and heart rate PreviousNext Question 5 of 12
A prenatal class is learning about labor and birth. Approximately ________% of newborns require some assistance to begin breathing at birth? Answers 30% 10% 5% 1% PreviousNext Question 6 of 12 Your hospital is planning Neonatal Resuscitation Program training and trying to decide who should be included. For every delivery, who should be available? Answers Someone should be identified at every delivery as the person to call for help with the baby Someone capable of initiating resuscitation should be present at every delivery and available to care for the baby Someone skilled in neonatal resuscitation should be available in the hospital to be called for deliveries Someone capable of initiating resuscitation should be present if risk factors are identified PreviousNext Question 7 of 12 You have determined that a baby needs resuscitation at birth. What are the initial steps of resuscitation? Answers Provide warmth, position head to open airway, evaluate heart rate. Provide warmth, position head to open the airway, dry and stimulate. Provide warmth, evaluate color and respirations, evaluate heart rate. Position head to open the airway, dry and stimulate, evaluate heart rate. PreviousNext Question 8 of 12 You are called to attend to a newborn at birth. Which 3 questions should you ask to help assess the need for resuscitation? Answers Is the baby of term gestation? Is the baby breathing or crying? Does the baby have good tone? Is the amniotic fluid clear? Is the baby breathing or crying? Is the baby of low birth weight? Is the baby warm? Does the baby have good tone? Is the of baby full-term gestation? Is the baby pink? Is the baby breathing or crying? Is the amniotic fluid clear? PreviousNext Question 9 of 12 A baby is born at 34 weeks’ gestation. Despite initial steps being taken, the baby is apneic and the heart rate is 70 beats per minute. What steps should be taken next? Answers Begin positive-pressure ventilation, place an oximeter probe on the right hand or wrist, reevaluate in 30 seconds. ister free-flow oxygen, place oximeter probe on right hand or wrist, reevaluate in 30 seconds. ister continuous positive airway pressure (AP), place an oximeter probe on the right hand or wrist, evaluate color and tone. Provide additional tactile stimulation, evaluate color and tone, reevaluate in 30 seconds. PreviousNext Question 10 of 12 You are called to a vacuum-assisted vaginal delivery that follows a period of non-reassuring fetal heart rate tracing. The baby emerges without a cry.
What physiologic response would your assessment that the baby is in primary apnea, but not secondary apnea? Answers Respirations begin only after positive-pressure ventilation. Blood pressure falls over several minutes. Respirations begin in response to tactile stimulation. Heart rate increases only after epinephrine istration. PreviousNext
Question 11 of 12 Your hospital is staffed by several people skilled in neonatal resuscitation. Most of them have additional responsibilities away from the delivery room, a While extra people may be useful, when should you first start to recruit additional help? Answers When, after birth, the obstetrician or labor nurse suggests that you need additional help When, after birth, you determine that the baby requires intubation or other procedures When you learn it is the birth of a multiple gestation, to care for the additional babies When you anticipate the likely need for more advanced resuscitation based on the presence of any of the known perinatal risk factors PreviousNext
Question 12 of 12 After several hours of labor with failure to progress, a baby is born via cesarean section. The baby cries at birth and is vigorous, but appears slightly dus How long may it take for this normal baby to achieve an oxygen saturation of 90% or greater? Answers 1 minute 2 minutes 5 minutes 10 minutes Previous
Lesson 2: Initial Steps of Resuscitation Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 What is the best technique for removing secretions from the mouth and nose of a newborn who requires resuscitation? Answers Suction the nose before the mouth. Suction the mouth or nose first. Suction vigorously and deeply to clear secretions. Suction the mouth before the nose. Next Question 2 of 12 Which statement best describes normal transitional physiology at the time of birth? Answers
The oxygen saturation normally rises to at least 90% by 2 minutes of age. Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. Oxygen saturation is unreliable, and 100% oxygen is often needed immediately after birth. Evaluation of skin color is a reliable indicator of the baby’s transition. PreviousNext Question 3 of 12 During a resuscitation of a newborn, what is the ideal head position? Answers The neck should be slightly flexed. The baby should be prone, with the head turned to the left. The baby should be prone, with the head turned to the right. The neck should be mildly extended. PreviousNext Question 4 of 12 Which statement accurately describes the role of oxygen in newborn resuscitation? Answers Free-flow oxygen may be istered using an oxygen mask held close to the baby’s face. Most newborn resuscitations should begin with 100% oxygen. A newborn in secondary apnea can be expected to resume normal respirations with the application of free-flow oxygen. It is reasonable to expect most babies have a pre-ductal saturation (Spo 2) of >90% by 3 minutes of age. PreviousNext Question 5 of 12 What is the most effective maneuver to establish normal breathing in a baby with secondary apnea? Answers Application of positive-pressure ventilation Gentle rubbing of the back istration of free-flow oxygen Flicking of the soles of the feet PreviousNext Question 6 of 12 A baby is born with meconium-stained amniotic fluid. The baby has normal muscle tone and respiratory effort and a heart rate of 120 beats per minute. What is the appropriate action? Answers Application of supplemental oxygen istration of mild chest physiotherapy Intubation and suctioning of the trachea Clearance of secretions from the mouth and nose with a bulb syringe PreviousNext Question 7 of 12 What is the best way to determine if a baby requires supplemental oxygen in the delivery room? Answers Send an arterial blood gas, and evaluate the partial pressure of oxygen. Place an oximeter on the baby’s right hand or wrist. Determine the color of the baby’s chest and abdomen, and monitor for central cyanosis. Determine the color of the baby’s hands and feet. PreviousNext Question 8 of 12 You are at the resuscitation of a newborn who is gasping and has a heart rate of 90 beats per minute.
What is the most important action you can take? Answers Assist ventilation. Provide chest compressions. Apply mild chest physiotherapy. Provide free-flow oxygen. PreviousNext Question 9 of 12 Which statement describes best practice when using a pulse oximeter? Answers The combination of an appropriately placed oximeter and knowledge of minute-by-minute normal oxygen targets should guide resuscitation. The probe should be attached to the instrument prior to attaching it to the baby, to ensure the most rapid acquisition of a signal. The probe should be placed in a reliable post-ductal location to guide the application of supplemental oxygen in the newborn. Once the oximeter is placed in a pre-ductal location, begin resuscitation with 100% oxygen and titrate downward. PreviousNext Question 10 of 12 What is the appropriate technique to stimulate a baby to breathe? Answers Holding the baby upside down and gently patting the buttocks Vigorously rubbing the back Slapping or flicking the soles of the feet Application of mild ocular pressure PreviousNext
Question 11 of 12 During the resuscitation of a newborn, you palpate the umbilical cord and count 10 beats over a 6-second period. What heart rate do you report to your t Answers 30 beats per minute 60 beats per minute 100 beats per minute 120 beats per minute PreviousNext Question 12 of 12 You are at a delivery of a baby born through meconium-stained amniotic fluid. What is the correct indication for intubating and suctioning the trachea at birth? Answers The baby is not pink by 1 minute of life. The baby has wet-sounding lungs. The baby has poor tone and respiratory effort. The meconium is thick. Previous
Lesson 3: Use of Resuscitation Devices for Positive-Pressure Ventilation Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination.
• • • •
Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 You attend the birth of a neonate at 30 weeks’ gestation who needs respiratory . What concentration of oxygen should be used in the resuscitation of this preterm baby? Answers Start with room air and adjust to keep oxygen saturations in target range. Start with 100% oxygen and adjust to keep oxygen saturations in target range. Start with a concentration somewhat higher than room air and adjust to keep oxygen saturations in target range. Start with 100% oxygen and adjust concentration based on color. Next
Question 2 of 12 A preterm newborn has respiratory distress after birth. Her heart rate is above 100 beats per minute, but she appears dusky. A team member has placed a What level of oxygen saturation should you try to achieve? Answers Adjust your oxygen to keep the saturation at the level at which the baby appears pink to the team. Adjust the oxygen level to achieve the target levels for oxygen saturation according to the baby’s age in minutes. Adjust the oxygen level to keep the saturation levels between 85% to 95%. Adjust the oxygen level to ensure that the saturation level is always 90% or greater. PreviousNext
Question 3 of 12 You attend the birth of a newborn with another caretaker. The baby is born limp and apneic. Despite initial steps, you are required to provide the newbo Answers Listen for breath sounds, begin chest compressions, and prepare for intubation and medications. Apply the pulse oximeter probe to any extremity, increase the oxygen concentration to 100%, and call for additional help. Apply the pulse oximeter probe to the right hand or wrist, take over ventilations, and increase the heat on the radiant warmer. Apply the pulse oximeter probe to the right hand or wrist, listen for a rising heart rate, and watch for rising oxygen saturations. PreviousNext
Question 4 of 12 You are giving positive-pressure ventilation to a premature newborn in your delivery room; both a flow-inflating bag and a T-piece resuscitator are avail What features of these two devices differ, making you consider using the T-piece resuscitator instead of the flow-inflating bag? Answers Only the T-piece resuscitator reliably delivers 100% oxygen. Only the T-piece resuscitator delivers consistent, reliable pressure with each breath. Only the T-piece resuscitator has an adjustable valve to regulate the amount of continuous positive airway pressure or positive end-expiratory pressure. Only the T-piece resuscitator can be used to deliver continuous positive airway pressure. PreviousNext
Question 5 of 12 You are part of a team resuscitating a premature newborn. Shortly after birth, the baby developed apnea, followed by bradycardia. Positive-pressure ven potential corrective steps, using the acronym MR SOPA. Despite taking the first 4 corrective steps, M-R-S-O, there is still no chest rise. You What are the final 2 corrective steps in the acronym MR SOPA? Answers P: Push chest (compressions) A: Airway alternative. P: Pressure increase, A: Add drugs (epinephrine). P: Pressure increase, A: Airway alternative.
P: Provide more oxygen, A: Ask for help. PreviousNext Question 6 of 12 You are giving positive-pressure ventilation to a baby, but there is no improvement. What are the first steps you should take to correct possible problems? Answers M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: give more Oxygen. M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly. M: Mask readjustment, R: Reposition the baby on his/her side, S: Suction the mouth and nose, O: Open the mouth slightly. M: Move the baby to a firm surface, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly. PreviousNext Question 7 of 12 A baby is apneic, and has a heart rate less than 100 beats per minute. You have provided positive pressure-ventilation for 30 seconds. What are the signs that positive-pressure ventilation has been effective and may be discontinued? Answers The heart rate is above 60 beats per minute, and the baby is making some respiratory effort. The heart rate has increased to greater than 100 beats per minute, and the baby is making some respiratory effort. The heart rate has increased to greater than 100 beats per minute, and the oxygen saturation is in the target range. The heart rate has increased to greater than 100 beats per minute, and the baby has sustained spontaneous breathing. PreviousNext
Question 8 of 12 A full-term baby is born following an emergency cesarean delivery for non-reassuring fetal heart rate patterns. The baby is apneic at birth, despite tacti What is the single most important and effective step in resuscitation of this newborn? Answers istration of supplemental oxygen Providing additional tactile stimulation Chest compressions Ventilating the lungs PreviousNext Question 9 of 12 You are giving positive-pressure ventilation to a baby because he is apneic and bradycardic. What is the most important indicator of successful positive-pressure ventilation? Answers Improvement in tone and movement A rising heart rate Audible and bilateral breath sounds Chest rise with each breath PreviousNext Question 10 of 12 A full term newborn is apneic at birth and requires positive-pressure ventilation.
What concentration of oxygen should be used during resuscitation? Answers Room air may be used to start resuscitation of full-term newborns, with concentration adjusted based on the target oxygen saturation for the age in minu 40% to 60% oxygen should be used for resuscitation of full-term newborns, independent of color or oxygen saturation. Room air should be used for resuscitation of full-term newborns, independent of color or oxygen saturation. 100 % oxygen should be used if the baby is a full-term newborn, independent of color or oxygen saturation.
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Question 11 of 12 A baby is born in the hospital lobby as his mother waited for ission. He is apneic, despite tactile stimulation, drying, and bulb suctioning. You have What should your next step be? Answers Start positive-pressure ventilation using room air, and transport the baby to a care area. Call for someone to bring a 100% oxygen tank and oximeter to the patient before starting positive-pressure ventilation. Quickly transport the baby to a care area, and start positive-pressure ventilation with blended oxygen and monitor with an oximeter. Monitor the heart rate; if it slows, begin positive-pressure ventilation with room air. PreviousNext Question 12 of 12 A baby is noticed to have unusual breathing after birth. Which finding is an indication for using positive-pressure ventilation? Answers Chest asymmetry Marked tachypnea Apnea or gasping Grunting and retractions Previous
Lesson 4: Chest Compressions Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 Which is the appropriate position on this baby to apply chest compressions? Answers A C B D Next
Question 2 of 12 A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute. What is your next action? Answers Stop both chest compressions and positive-pressure ventilation. Continue chest compressions and positive-pressure ventilation. Stop chest compressions; continue positive-pressure ventilation.
ister epinephrine while continuing chest compressions and positive-pressure ventilation. PreviousNext Question 3 of 12 What is the preferred technique for chest compressions? Answers 2-thumb technique 2-finger technique Fist technique Heel-of-hand technique PreviousNext Question 4 of 12 When are chest compressions indicated? Answers Whenever the heart rate is less than 60 beats per minute When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation Whenever the heart rate is less that 100 beats per minute PreviousNext Question 5 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers remain in with the chest at all times. Ventilate whenever possible. 2:1 ratio of compressions to breaths is being used. Compression depth is one fourth the diameter of the chest. PreviousNext
Question 6 of 12 A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos seconds. What should the next step in the resuscitation process should be? Answers Provide free-flow oxygen, and begin initiating chest compressions. Continue stimulating the baby for an additional 30 seconds. Provide positive-pressure ventilation for at least 30 seconds. Initiate chest compressions using the 2-thumb technique. PreviousNext Question 7 of 12 Which of the following is a potential danger of istering chest compressions? Answers Gaseous distension of the stomach and intestinal tract Traumatizing the spinal column Providing excessive blood flow to vital organs Fracturing ribs or injuring the liver PreviousNext Question 8 of 12 Your team begins istering chest compressions to a newborn.
Correct technique includes which of the following? Answers Thumbs or fingers are lifted off the chest during the relaxation phase. Compression depth is one-fourth the diameter of the chest. Chest compressions and ventilation are well coordinated. A 2:1 ratio of compressions to breaths is being used. PreviousNext
Question 9 of 12 A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch What do you do next? Answers Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate. Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes. Increase oxygen concentration to ensure that the baby is well oxygenated. Decrease oxygen concentration and discontinue pulse oximetry monitoring. PreviousNext Question 10 of 12 When chest compressions are indicated, you should also consider: Answers Immediately istering epinephrine Increasing the temperature setting of the radiant warmer Endotracheal intubation, if not already done Repositioning the baby’s head PreviousNext Question 11 of 12 When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? Answers 30 breaths, 90 compressions 60 breaths, 120 compressions 60 breaths, 60 compressions 40 breaths, 80 compressions PreviousNext Question 12 of 12 What is the ideal depth of chest compressions for a newborn? Answers One fourth the antero-posterior diameter of the chest Half the antero-posterior diameter of the chest One third the antero-posterior diameter of the chest Two thirds the antero-posterior diameter of the chest. Previous Lesson 4: Chest Compressions Examination Summary • This examination contains 12 question(s).
• • •
You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window.
• •
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 Which is the appropriate position on this baby to apply chest compressions? Answers A C B D Next
Question 2 of 12 A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute. What is your next action? Answers Stop both chest compressions and positive-pressure ventilation. Continue chest compressions and positive-pressure ventilation. Stop chest compressions; continue positive-pressure ventilation. ister epinephrine while continuing chest compressions and positive-pressure ventilation. PreviousNext Question 3 of 12 What is the preferred technique for chest compressions? Answers 2-thumb technique 2-finger technique Fist technique Heel-of-hand technique PreviousNext Question 4 of 12 When are chest compressions indicated? Answers Whenever the heart rate is less than 60 beats per minute When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation Whenever the heart rate is less that 100 beats per minute PreviousNext Question 5 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers remain in with the chest at all times. Ventilate whenever possible. 2:1 ratio of compressions to breaths is being used. Compression depth is one fourth the diameter of the chest. PreviousNext
Question 6 of 12 A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos seconds.
What should the next step in the resuscitation process should be? Answers Provide free-flow oxygen, and begin initiating chest compressions. Continue stimulating the baby for an additional 30 seconds. Provide positive-pressure ventilation for at least 30 seconds. Initiate chest compressions using the 2-thumb technique. PreviousNext Question 7 of 12 Which of the following is a potential danger of istering chest compressions? Answers Gaseous distension of the stomach and intestinal tract Traumatizing the spinal column Providing excessive blood flow to vital organs Fracturing ribs or injuring the liver PreviousNext Question 8 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers are lifted off the chest during the relaxation phase. Compression depth is one-fourth the diameter of the chest. Chest compressions and ventilation are well coordinated. A 2:1 ratio of compressions to breaths is being used. PreviousNext
Question 9 of 12 A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch What do you do next? Answers Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate. Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes. Increase oxygen concentration to ensure that the baby is well oxygenated. Decrease oxygen concentration and discontinue pulse oximetry monitoring. PreviousNext Question 10 of 12 When chest compressions are indicated, you should also consider: Answers Immediately istering epinephrine Increasing the temperature setting of the radiant warmer Endotracheal intubation, if not already done Repositioning the baby’s head PreviousNext Question 11 of 12 When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? Answers 30 breaths, 90 compressions 60 breaths, 120 compressions 60 breaths, 60 compressions 40 breaths, 80 compressions
PreviousNext Question 12 of 12 What is the ideal depth of chest compressions for a newborn? Answers One fourth the antero-posterior diameter of the chest Half the antero-posterior diameter of the chest One third the antero-posterior diameter of the chest Two thirds the antero-posterior diameter of the chest. Previous Lesson 5: Endotracheal Intubation and Laryngeal Mask Airway Insertion Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth we Answers 2.5 mm 3.0 mm 2.0 mm 3.5 mm Next Question 2 of 12 You are uncertain whether you have successfully intubated a newborn. Which of the following is an indication that the endotracheal tube is correctly placed in the trachea, and not in the esophagus? Answers Continued cyanosis and bradycardia. Air is heard entering the stomach. No vapor (mist) is detected in the endotracheal tube. Carbon dioxide detector indicates the presence of expired carbon dioxide. PreviousNext
Question 3 of 12 A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of bag-and-mask ventilation. Your team plans to intubate. Which
Question 5 of 12 You are part of a team resuscitating a baby who has meconium-stained fluid. A person experienced in endotracheal intubation should be Answers Called in from home when a baby is born and requires intubation. Immediately available to the resuscitation team to assist at every delivery.
Not necessary if another team member knows how to place a laryngeal mask airway. Called from an office near the hospital. PreviousNext Question 6 of 12 What is the approximate period within which one should ideally be able to intubate a newborn? Answers 60 seconds 30 seconds 40 seconds 20 seconds PreviousNext Question 7 of 12 You have successfully intubated a newborn with an estimated 35-week gestational age newborn and an estimated birth weight of 2 kg. What is the correct tip-to-lip depth of tube insertion for correct placement in the mid-trachea? Answers 6 cm 7 cm 9 cm 8 cm PreviousNext Question 8 of 12 Which of the following is an indication for intubation? Answers The presence of thick meconium in a vigorous newborn who must be suctioned The need to ister continuous positive airway pressure The need for positive-pressure ventilation lasting beyond a few minutes An estimated gestational age of less than 28 weeks PreviousNext Question 9 of 12 What size (internal diameter) endotracheal tube should you use when intubating a newborn of 30 weeks’ gestation with a birth weight of 1,200 g? Answers 3.0 mm 2.5 mm 4.0 mm 3.5 mm PreviousNext Question 10 of 12 What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks (estimated birth weight of 1,200 g)? Answers 2 00 0 1 PreviousNext Question 11 of 12 You are practicing the use of an algorithm to direct the sequence of interventions to correct ventilation. In which situation will the placement of a laryngeal mask airway be useful?
Answers When a term newborn with thick meconium has respiratory depression at birth When positive-pressure ventilation with a face mask fails to achieve effective ventilation and intubation is not possible When a newborn has facial or upper airway malformations and is breathing comfortably When a 30-week preterm newborn requires surfactant in the delivery room PreviousNext
Question 12 of 12 What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 38 weeks and an estimated birth weight of 3200 Answers 1 00 0 2 Previous Lesson 6: Medications Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 During resuscitation, one of your team suggests that the baby might benefit from a bolus of fluid. Which of the following is an indication for volume expansion during resuscitation? Answers The baby’s heart rate is 110 after resuscitative efforts and there is a history of extensive vaginal bleeding during labor The baby’s heart rate is 120 after resuscitative efforts but she is very pale The baby’s heart rate remains 70 after resuscitative efforts and pulses are weak The baby’s heart rate is increasing with resuscitative efforts but his pulses seem weak Next
Question 2 of 12 You are called to an emergency cesarean delivery of a 28-week gestational age baby because of prolonged rupture of membranes, chorioamnionitis, and the baby is non-vigorous with apnea, very poor tone, and a gray color. The baby appears to be about 1 kg. You place the newborn in plastic wrap, cover stimulate, but the baby remains apneic with a heart rate of 30 beats per minute. You initiate ventilation but have no improvement in heart rate or chest m pressure (MR SOPA). You quickly intubate, confirm appropriate endotracheal tube placement, and secure the tube. The heart rate continues to be 30 bea improvement in heart rate. You decide to ister epinephrine and a team member places an umbilical venous catheter. What dose of 1:10,000 concentration epinephrine will best result in return of spontaneous circulation? Answers 0.1 ml epinephrine via intravenous istration 0.5 ml epinephrine via endotracheal tube istration 0.5 ml epiephrine via intravenous istration 0.1 ml epinephrine via endotracheal tube istration PreviousNext
Question 3 of 12 A 32-week gestational age baby is delivered following 50% abruption and has not responded to the initial steps of resuscitation, 30 seconds of positive-p positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is istered. The epinephrine should be istered over the following timeframe
Answers Over 1 to 2 minutes Over 5 to 10 minutes Rapid push as quickly as possible Over 3 to 5 minutes PreviousNext Question 4 of 12 Which fluid is not a reasonable choice for volume expansion? Answers Ringer’s lactate Normal saline Placental blood drawn through umbilical vein O Rh-negative blood PreviousNext
Question 5 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to 60 seconds of cardiac compressions coordinated with positive pressure ventilation in a 3:1 ratio. You decide to ister intravenous epinephrine. Which vessel in the drawing should be used? Answers C B A PreviousNext
Question 6 of 12 You are called to an emergency cesarean delivery of a term baby due to a Category 3 fetal heart rate monitoring strip. At your request, additional help ha Despite repositioning, drying and stimulation, the newborn remains apneic with a heart rate of 30 beats per minute. You initiate ventilation and achieve and secure the tube. The heart rate is now 30 beats per minute, and a team member begins chest compressions. Together you provide 45 to 60 seconds o epinephrine via the endotracheal tube while another team member obtains IV access. What is the appropriate dose of 1:10,000 concentration of epinephrine for endotracheal delivery to a 3 kg baby? Answers 0.5 ml epinephrine via endotracheal tube 1.5 ml epinephrine via endotracheal tube 0.3 ml epinephrine via endotracheal tube 0.9 ml epinephrine via endotracheal tube PreviousNext Question 7 of 12 Which of the following medications may be used during the first several minutes of neonatal resuscitation? Answers Calcium Epinephrine Atropine Sodium bicarbonate PreviousNext
Question 8 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. An emergency umbilical venous catheter is placed. The catheter should be inserted
Answers Just as far as the length of the umbilical stump Two thirds of the shoulder-to-umbilical distance Just far enough to get blood return to a depth of 10 to 11 cm PreviousNext
Question 9 of 12 You are called to an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and late decelerations t meconium staining, and a gray color. You quickly intubate and suction for meconium; none is obtained below the cords. You then reposition the baby, dr What is the most appropriate next step of resuscitation? Answers Intubate and ister 0.05 mg/kg of endotracheal epinephrine. Start cardiac compressions coordinated 3:1 with ventilation. Initiate effective positive-pressure ventilation for 30 seconds and reassess the heart rate. Continue rubbing the back of the baby with a towel to increase stimulation. PreviousNext Question 10 of 12 How soon after delivery of epinephrine should you recheck the baby’s heart rate? Answers 1 minute 30 seconds 5 minutes 10 to 15 seconds PreviousNext
Question 11 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to 60 seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is istered. What is the most important effect of epinephrine? Answers Increase heart rate via improved coronary perfusion pressure via its peripheral vasoconstrictive effects. Increase heart rate via increased chronotropy. Increase heart rate via increased inotropy. Increase heart rate via increased pulmonary vasoconstriction. PreviousNext
Question 12 of 12 If a newborn’s heart rate remains less than 60 beats per minute after positive-pressure ventilation and chest compressions, you should do all of the follow Answers Establish intravenous access for istration of epinephrine. Check to ensure that ventilation is producing adequate lung inflation, and cardiac compressions are being done correctly. ister sodium bicarbonate. ister subsequent epinephrine doses (if needed) in 3- to 5-minute intervals. Previous Lesson 7: Special Considerations Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar.
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Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 While resuscitating a term newborn, you observe that the baby has severe respiratory distress and an unusually flat abdomen, with no air entry on the lef Which of the following is the most likely diagnosis? Answers Pierre Robin syndrome Pulmonary hypoplasia Left choanal atresia Congenital diaphragmatic hernia Next Question 2 of 12 During positive-pressure ventilation of a newborn, the breath sounds suddenly become inaudible on one side of the chest. Which of the following statements is true? Answers Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed superior In the delivery room, a pneumothorax should only be evacuated from the 4th intercostal space in the midclavicular line In the delivery room, a pneumothorax should only be evacuated from the 2nd intercostal space in the anterior axillary line Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed inferior PreviousNext Question 3 of 12 Which of the following are special steps necessary in the resuscitation of a newborn with suspected congenital diaphragmatic hernia? Answers with continuous positive airway pressure and a high oxygen concentration Endotracheal intubation and placement of an orogastric tube Bag-and-mask ventilation at a high rate with no end-expiratory pressure Bag-and-mask ventilation with high peak inspiratory pressure and high positive end-expiratory pressure PreviousNext Question 4 of 12 Which of the following is true about pneumothoraces in the newborn? Answers A chest radiograph must always be obtained prior to evacuating a pneumothorax The risk of pneumothorax is increased if positive-pressure ventilation is provided Pneumothoraces rarely complicate congenital diaphragmatic hernia Every pneumothorax requires immediate evacuation PreviousNext Question 5 of 12 A baby does not appear to be improving after intubation. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? Answers Laryngeal web Congenital goiter Pierre Robin syndrome Malpositioned endotracheal tube PreviousNext
Question 6 of 12 A baby under your care has severe respiratory distress after birth, but can be easily ventilated with positive-pressure ventilation by mask. How can you test for choanal atresia? Answers Place a carbon dioxide detector over each of the nares. Attempt to an endotracheal tube through each naris into the posterior pharynx. Obtain lateral skull radiographs to determine patency of the nares. Attempt to a suction catheter through each naris into the posterior pharynx. PreviousNext
Question 7 of 12 A 10-day-old, mechanically ventilated newborn suddenly develops bradycardia and low oxygen saturation, despite the oxygen concentration being incre What is the first and the most important step in the resuscitation of this newborn? Answers Begin chest compressions at a rate of 90 events per minute. Assess and establish adequate ventilation. ister 10 mL/kg normal saline bolus over 5 to 10 minutes. Obtain a 12-lead electrocardiogram. PreviousNext Question 8 of 12 Which of the following statements is true about the use of therapeutic hypothermia in a baby with hypoxic-ischemic encephalopathy? Answers The improvement in outcome from this therapy is directly related to the degree of hypothermia. Therapeutic hypothermia has been demonstrated to improve neurologic outcomes in newborns of all gestational ages. Therapeutic hypothermia is effective if initiated at any time within the first 24 hours. Therapeutic hypothermia requires specialized equipment, and should only be used according to well defined protocols. PreviousNext Question 9 of 12 A baby is unable to breath adequately after birth. Which of the following statements is true? Answers Severe pulmonary hypoplasia usually is incompatible with survival. Pulmonary hypoplasia is rarely associated with pneumothoraces. Pulmonary hypoplasia may result from any cause of polyhydramnios. Hypoplastic lungs are easily ventilated with low inflation pressures. PreviousNext
Question 10 of 12 Your team is resuscitating a preterm newborn. Positive-pressure ventilation with bag and mask has resulted in good bilateral air entry, normal heart rate, Which of the following is the most likely cause of ineffective respirations in this newborn? Answers Maternal treatment with terbutaline Maternal treatment with magnesium sulfate Pulmonary hypoplasia Congenital heart disease PreviousNext Question 11 of 12 ing the MR SOPA acronym helps your team correct problems with ventilation. Which of the following steps are included in MR SOPA? Answers
Mask seal ensured, Reposition head of baby, Suction the airway Mask seal ensured, Repeat stimulation, Suction the airway Mouth opened, Repeat stimulation, Saturation check Mouth opened, Reposition head, Saturation check PreviousNext Question 12 of 12 You have established a team to help care for a newborn with a known congenital heart defect. Which of the following statements is true for babies with major congenital heart disease? Answers These babies will have poor respiratory drive as a result of the heart disease. These babies will always have a heart murmur on exam at birth. These babies are rarely critically ill immediately following birth. The diagnosis of congenital heart disease in these babies can almost always be established in the delivery room. Previous
Lesson 8: Resuscitation of Babies Born Preterm Examination Summary • This examination contains 7 question(s).
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You must answer 80% correctly or 6 out of 7 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 7 You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby’s mother had a fever and chorioamnionitis. Resuscitation ha Which of the following is a true statement about the baby’s subsequent care? Answers Supplemental oxygen should be provided to maintain the baby’s oxygen saturation equal to or above 98%. Enteral feedings should be started immediately and advanced rapidly to ensure adequate nutrition. Antibiotics are not indicated because the risk of infection is low following preterm birth. Blood glucose levels should be monitored because glycogen stores may be rapidly depleted after resuscitation. Next
Question 2 of 7 You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby is 5 minutes old and breathing spontaneously. Heart rate is becoming labored. Which of the following is an appropriate action? Answers ister positive-pressure ventilation with an initial inflation pressure of 30 to 35 cm H 2O. Provide supplemental oxygen to rapidly increase the baby’s oxygen saturation above 95%. Provide vigorous stimulation on the back, trunk, and extremities. ister 5 to 6 cm H2O continuous positive airway pressure. PreviousNext Question 3 of 7 You have been called to attend the birth of a baby at 25 weeks’ gestation, with an estimated fetal weight of 750 g.
Which of the following is a true statement about the preparation and resources needed for this preterm birth? Answers A compressed air source, oxygen blender, and pulse oximeter should be in the room and available for immediate use. The delivery room temperature should be decreased to approximately 65ºF to 66ºF (18.3ºC to 18.8ºC) to avoid hyperthermia. A size 1 laryngoscope and size 3.5-mm endotracheal tube should be prepared for the initial intubation attempt, in the event that the baby has respiratory Personnel skilled in intubation and umbilical catheter placement may be on call at home or in another area of the hospital. PreviousNext Question 4 of 7 You have been called to attend the birth of a baby at 25 weeks’ gestation, with an estimated fetal weight of 750 g. Which of the following is a true statement about the complications that may occur in this extremely premature baby compared to a term newborn? Answers The baby’s body-surface area decreases heat loss and increases the risk of developing hyperthermia. The baby’s muscles and surfactant deficiency make effective spontaneous ventilation more difficult to achieve. The baby’s underdeveloped lungs are less likely to be injured by positive-pressure ventilation and high concentrations of oxygen. The lack of blood vessel development in the baby’s brain decreases the risk of developing intracranial bleeding. PreviousNext Question 5 of 7 What resources are needed to prepare for a preterm birth? Answers Additional means to maintain body temperature should be prepared, such as reclosable polyethylene bags and a portable warming pad. All of these. Additional trained personnel should be requested, including someone with expertise performing endotracheal intubation. A pulse oximeter and an oxygen blender should be available in the delivery room. PreviousNext
Question 6 of 7 You are in the delivery room caring for a preterm newborn at 28 weeks’ gestation. The baby was intubated for poor respiratory effort, and you are provid oximeter on the right wrist; after 10 minutes, oxygen saturation is 80% and not rising. Which of the following is an appropriate action? Answers Increase the oxygen concentration. Ventilate without positive end-expiratory pressure. Move the pulse oximeter to the baby’s left wrist. Insert an orogastric tube. PreviousNext Question 7 of 7 You recognize that premature newborns are vulnerable to hyperoxia and you have an oximeter and blender in your delivery room. What action is appropriate with this equipment during and immediately following resuscitation of babies born preterm? Answers Adjusting the inspired oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 5 to 10 minutes after birth. Relying on the oximeter saturation reading when the heart rate displayed on the oximeter is different from the heart rate you hear with a stethoscope. Turning up the inspired oxygen concentration if you note saturations of 70% to 80% during the first 2 minutes of life. Always initiating ventilation with 21% oxygen (0.21 FiO2) in such babies. Previous HhLesson 9: Ethics and Care at the End of Life Examination Summary • This examination contains 10 question(s).
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You must answer 80% correctly or 8 out of 10 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 10 A woman is itted at 24 weeks’ gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born within the ne
What is likely to be helpful in this process? Answers It is worth obtaining up-to-date outcome data for your institution or region, or using the Neonatal Resuscitation Program Web site and National Instutite It is best to wait until the mother has received some medications, such as magnesium sulfate or analgesics, as these often help relieve her anxiety and the The obstetrician and neonatologist should ideally meet separately with the parents, so the full range of perspectives and possibilities is most clear. Make sure you cover all material in one session because repeated discussions tend to increase anxiety and limit understanding. Next Question 2 of 10 You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability and whose birth is imminent.
What should you tell the parents when they ask you how decisions about resuscitation are made? Answers You offer to bring an ultrasonographer to the birth so that the baby can be immediately assessed for the presence of an intracranial hemorrhage, to guide The decision agreed to before birth may need to be modified based on the condition of the baby after birth and the postnatal gestational age assessment. You will categorically honor and follow whatever decision - to initiate or withhold resuscitation - you reach together prior to birth. While the parents are important people, only you and the other caregivers have the knowledge and ultimate responsibility to make decisions on resuscita PreviousNext Question 3 of 10 In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn? Answers The of the resuscitation team The delivering obstetrician The hospital chaplain The parents PreviousNext Question 4 of 10 You are called to the birth of a newborn weighing 385 g and gestational age of just under 23 weeks, a birth weight that is associated with almost certain Which action is appropriate? Answers Attempts at resuscitation are not indicated under these circumstances; care should focus on comfort alone. Attempts at resuscitation are indicated and expected if your team is called to a birth. Attempts at resuscitation can be delayed for up to five minutes to allow time to determine whether the baby might respond. Attempts at resuscitation should only be done after consultation with the hospital ethics committee. PreviousNext Question 5 of 10 Good decisions are based on good data. Which statement about obstetric dating and assessment is correct? Answers Fetal weight can not be estimated if there is intrauterine growth restriction. Dating can be reliably based on the ultrasound calculations of fetal weight. Techniques for dating are accurate to within 1 to 2 days, when they are performed in the second half of pregnancy. Techniques for obstetric dating are accurate to within 3 to 5 days, when assessed during the first trimester.
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Question 6 of 10 Which statement describes the ethical principle(s) that guide the resuscitation of a newborn? Answers The approach to decisions in the newborn should be guided by the same principles used for adults and older children. The decisions are the responsibility of the parent(s) and cannot be challenged by caregivers. The baby is a minor and any decisions on performing or discontinuing resuscitation should be made during an emergency meeting of the hospital ethics The ethical principles of beneficence, nonmaleficence, autonomy, and justice are used for adults and older children, but do not apply to newborns. PreviousNext Question 7 of 10 You are counseling a set of 17-year-old parents, whose baby is about to be born at 23 weeks’ gestation. You have explained that survival is unlikely and that everything be done, starting with resuscitation at birth. How might you answer them? Answers You explain that your first obligation is to do no harm and given the statistics, you will not begin resuscitation. You tell them you are glad they made this choice because federal law requires you to do this anyway. You assure them that as the parents, they are the appropriate voice for their baby and you will their wishes. You tell them that because they are younger than the legal voting age, they are not able to make final decisions and you will take that responsibility. PreviousNext
Question 8 of 10 You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks’ gestation. The newborn emerg monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with medications; fluids; and performance of chest compressions). After what duration of time might it be appropriate to discontinue resuscitative efforts? Answers After 10 minutes of no detectable heart rate (Asystole) After 5 minutes of no detectable heart rate (Asystole) After 20 minutes of no detectable heart rate (Asystole) After 30 minutes of no detectable heart rate (Asystole) PreviousNext
Question 9 of 10 In the course of planning care for a newborn with a known genetic disorder, one of your team suggests that no resuscitation be offered. The pa Which of the following statements is true? Answers Withdrawal or non-initiation of may be acceptable if there is agreement between parents and the treating team that this will be futile. It is better to withhold resuscitation because once you start, you are obligated to continue life . If the parents request no resuscitation, there is no situation in which a caregiver can legally go against their wishes United States federal law mandates resuscitation of all newborns regardless of underlying conditions PreviousNext Question 10 of 10 When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents Answers The resuscitation team alone will make the appropriate decision after birth. The hospital ethics committee must be consulted in order to make a decision. The option of only providing comfort care can be considered. No resuscitation will be started under any circumstances.
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 A full-term newborn is apneic after birth and fails to respond to tactile stimulation. Newborns in secondary apnea usually respond with an increase in heart rate after which intervention? Answers istration of free-flow 100% oxygen Increasingly vigorous tactile stimulation Chest compressions at a rate of 30 per minute Effective positive-pressure ventilation Next Question 2 of 12 A caregiver states that he can always predict which babies will need help at birth. You disagree because you know that ____% of newborns require initial assessment to determine whether resuscitation is required. Answers 10% 1% 50% 100% PreviousNext Question 3 of 12 After the initial steps in resuscitation, a newborn is apneic with a heart rate less than 100 beats per minute. What is the most important and effective action to take in the resuscitation of this baby? Answers Provide supplemental oxygen. Ventilate the lungs. Give epinephrine. Perform chest compressions. PreviousNext Question 4 of 12 A newborn requires resuscitation, and you have begun positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions and the need to continue some aspect of ? Answers Respirations, heart rate, assessment of oxygenation Blood pressure, assessment of oxygenation, heart rate Respirations, blood pressure, assessment of oxygenation Respirations, muscle tone, and heart rate PreviousNext Question 5 of 12
A prenatal class is learning about labor and birth. Approximately ________% of newborns require some assistance to begin breathing at birth? Answers 30% 10% 5% 1% PreviousNext Question 6 of 12 Your hospital is planning Neonatal Resuscitation Program training and trying to decide who should be included. For every delivery, who should be available? Answers Someone should be identified at every delivery as the person to call for help with the baby Someone capable of initiating resuscitation should be present at every delivery and available to care for the baby Someone skilled in neonatal resuscitation should be available in the hospital to be called for deliveries Someone capable of initiating resuscitation should be present if risk factors are identified PreviousNext Question 7 of 12 You have determined that a baby needs resuscitation at birth. What are the initial steps of resuscitation? Answers Provide warmth, position head to open airway, evaluate heart rate. Provide warmth, position head to open the airway, dry and stimulate. Provide warmth, evaluate color and respirations, evaluate heart rate. Position head to open the airway, dry and stimulate, evaluate heart rate. PreviousNext Question 8 of 12 You are called to attend to a newborn at birth. Which 3 questions should you ask to help assess the need for resuscitation? Answers Is the baby of term gestation? Is the baby breathing or crying? Does the baby have good tone? Is the amniotic fluid clear? Is the baby breathing or crying? Is the baby of low birth weight? Is the baby warm? Does the baby have good tone? Is the of baby full-term gestation? Is the baby pink? Is the baby breathing or crying? Is the amniotic fluid clear? PreviousNext Question 9 of 12 A baby is born at 34 weeks’ gestation. Despite initial steps being taken, the baby is apneic and the heart rate is 70 beats per minute. What steps should be taken next? Answers Begin positive-pressure ventilation, place an oximeter probe on the right hand or wrist, reevaluate in 30 seconds. ister free-flow oxygen, place oximeter probe on right hand or wrist, reevaluate in 30 seconds. ister continuous positive airway pressure (AP), place an oximeter probe on the right hand or wrist, evaluate color and tone. Provide additional tactile stimulation, evaluate color and tone, reevaluate in 30 seconds. PreviousNext Question 10 of 12 You are called to a vacuum-assisted vaginal delivery that follows a period of non-reassuring fetal heart rate tracing. The baby emerges without a cry.
What physiologic response would your assessment that the baby is in primary apnea, but not secondary apnea? Answers Respirations begin only after positive-pressure ventilation. Blood pressure falls over several minutes. Respirations begin in response to tactile stimulation. Heart rate increases only after epinephrine istration. PreviousNext
Question 11 of 12 Your hospital is staffed by several people skilled in neonatal resuscitation. Most of them have additional responsibilities away from the delivery room, a While extra people may be useful, when should you first start to recruit additional help? Answers When, after birth, the obstetrician or labor nurse suggests that you need additional help When, after birth, you determine that the baby requires intubation or other procedures When you learn it is the birth of a multiple gestation, to care for the additional babies When you anticipate the likely need for more advanced resuscitation based on the presence of any of the known perinatal risk factors PreviousNext
Question 12 of 12 After several hours of labor with failure to progress, a baby is born via cesarean section. The baby cries at birth and is vigorous, but appears slightly dus How long may it take for this normal baby to achieve an oxygen saturation of 90% or greater? Answers 1 minute 2 minutes 5 minutes 10 minutes Previous
Lesson 2: Initial Steps of Resuscitation Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 What is the best technique for removing secretions from the mouth and nose of a newborn who requires resuscitation? Answers Suction the nose before the mouth. Suction the mouth or nose first. Suction vigorously and deeply to clear secretions. Suction the mouth before the nose. Next Question 2 of 12 Which statement best describes normal transitional physiology at the time of birth? Answers
The oxygen saturation normally rises to at least 90% by 2 minutes of age. Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%. Oxygen saturation is unreliable, and 100% oxygen is often needed immediately after birth. Evaluation of skin color is a reliable indicator of the baby’s transition. PreviousNext Question 3 of 12 During a resuscitation of a newborn, what is the ideal head position? Answers The neck should be slightly flexed. The baby should be prone, with the head turned to the left. The baby should be prone, with the head turned to the right. The neck should be mildly extended. PreviousNext Question 4 of 12 Which statement accurately describes the role of oxygen in newborn resuscitation? Answers Free-flow oxygen may be istered using an oxygen mask held close to the baby’s face. Most newborn resuscitations should begin with 100% oxygen. A newborn in secondary apnea can be expected to resume normal respirations with the application of free-flow oxygen. It is reasonable to expect most babies have a pre-ductal saturation (Spo 2) of >90% by 3 minutes of age. PreviousNext Question 5 of 12 What is the most effective maneuver to establish normal breathing in a baby with secondary apnea? Answers Application of positive-pressure ventilation Gentle rubbing of the back istration of free-flow oxygen Flicking of the soles of the feet PreviousNext Question 6 of 12 A baby is born with meconium-stained amniotic fluid. The baby has normal muscle tone and respiratory effort and a heart rate of 120 beats per minute. What is the appropriate action? Answers Application of supplemental oxygen istration of mild chest physiotherapy Intubation and suctioning of the trachea Clearance of secretions from the mouth and nose with a bulb syringe PreviousNext Question 7 of 12 What is the best way to determine if a baby requires supplemental oxygen in the delivery room? Answers Send an arterial blood gas, and evaluate the partial pressure of oxygen. Place an oximeter on the baby’s right hand or wrist. Determine the color of the baby’s chest and abdomen, and monitor for central cyanosis. Determine the color of the baby’s hands and feet. PreviousNext Question 8 of 12 You are at the resuscitation of a newborn who is gasping and has a heart rate of 90 beats per minute.
What is the most important action you can take? Answers Assist ventilation. Provide chest compressions. Apply mild chest physiotherapy. Provide free-flow oxygen. PreviousNext Question 9 of 12 Which statement describes best practice when using a pulse oximeter? Answers The combination of an appropriately placed oximeter and knowledge of minute-by-minute normal oxygen targets should guide resuscitation. The probe should be attached to the instrument prior to attaching it to the baby, to ensure the most rapid acquisition of a signal. The probe should be placed in a reliable post-ductal location to guide the application of supplemental oxygen in the newborn. Once the oximeter is placed in a pre-ductal location, begin resuscitation with 100% oxygen and titrate downward. PreviousNext Question 10 of 12 What is the appropriate technique to stimulate a baby to breathe? Answers Holding the baby upside down and gently patting the buttocks Vigorously rubbing the back Slapping or flicking the soles of the feet Application of mild ocular pressure PreviousNext
Question 11 of 12 During the resuscitation of a newborn, you palpate the umbilical cord and count 10 beats over a 6-second period. What heart rate do you report to your t Answers 30 beats per minute 60 beats per minute 100 beats per minute 120 beats per minute PreviousNext Question 12 of 12 You are at a delivery of a baby born through meconium-stained amniotic fluid. What is the correct indication for intubating and suctioning the trachea at birth? Answers The baby is not pink by 1 minute of life. The baby has wet-sounding lungs. The baby has poor tone and respiratory effort. The meconium is thick. Previous
Lesson 3: Use of Resuscitation Devices for Positive-Pressure Ventilation Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination.
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Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 You attend the birth of a neonate at 30 weeks’ gestation who needs respiratory . What concentration of oxygen should be used in the resuscitation of this preterm baby? Answers Start with room air and adjust to keep oxygen saturations in target range. Start with 100% oxygen and adjust to keep oxygen saturations in target range. Start with a concentration somewhat higher than room air and adjust to keep oxygen saturations in target range. Start with 100% oxygen and adjust concentration based on color. Next
Question 2 of 12 A preterm newborn has respiratory distress after birth. Her heart rate is above 100 beats per minute, but she appears dusky. A team member has placed a What level of oxygen saturation should you try to achieve? Answers Adjust your oxygen to keep the saturation at the level at which the baby appears pink to the team. Adjust the oxygen level to achieve the target levels for oxygen saturation according to the baby’s age in minutes. Adjust the oxygen level to keep the saturation levels between 85% to 95%. Adjust the oxygen level to ensure that the saturation level is always 90% or greater. PreviousNext
Question 3 of 12 You attend the birth of a newborn with another caretaker. The baby is born limp and apneic. Despite initial steps, you are required to provide the newbo Answers Listen for breath sounds, begin chest compressions, and prepare for intubation and medications. Apply the pulse oximeter probe to any extremity, increase the oxygen concentration to 100%, and call for additional help. Apply the pulse oximeter probe to the right hand or wrist, take over ventilations, and increase the heat on the radiant warmer. Apply the pulse oximeter probe to the right hand or wrist, listen for a rising heart rate, and watch for rising oxygen saturations. PreviousNext
Question 4 of 12 You are giving positive-pressure ventilation to a premature newborn in your delivery room; both a flow-inflating bag and a T-piece resuscitator are avail What features of these two devices differ, making you consider using the T-piece resuscitator instead of the flow-inflating bag? Answers Only the T-piece resuscitator reliably delivers 100% oxygen. Only the T-piece resuscitator delivers consistent, reliable pressure with each breath. Only the T-piece resuscitator has an adjustable valve to regulate the amount of continuous positive airway pressure or positive end-expiratory pressure. Only the T-piece resuscitator can be used to deliver continuous positive airway pressure. PreviousNext
Question 5 of 12 You are part of a team resuscitating a premature newborn. Shortly after birth, the baby developed apnea, followed by bradycardia. Positive-pressure ven potential corrective steps, using the acronym MR SOPA. Despite taking the first 4 corrective steps, M-R-S-O, there is still no chest rise. You What are the final 2 corrective steps in the acronym MR SOPA? Answers P: Push chest (compressions) A: Airway alternative. P: Pressure increase, A: Add drugs (epinephrine). P: Pressure increase, A: Airway alternative.
P: Provide more oxygen, A: Ask for help. PreviousNext Question 6 of 12 You are giving positive-pressure ventilation to a baby, but there is no improvement. What are the first steps you should take to correct possible problems? Answers M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: give more Oxygen. M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly. M: Mask readjustment, R: Reposition the baby on his/her side, S: Suction the mouth and nose, O: Open the mouth slightly. M: Move the baby to a firm surface, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly. PreviousNext Question 7 of 12 A baby is apneic, and has a heart rate less than 100 beats per minute. You have provided positive pressure-ventilation for 30 seconds. What are the signs that positive-pressure ventilation has been effective and may be discontinued? Answers The heart rate is above 60 beats per minute, and the baby is making some respiratory effort. The heart rate has increased to greater than 100 beats per minute, and the baby is making some respiratory effort. The heart rate has increased to greater than 100 beats per minute, and the oxygen saturation is in the target range. The heart rate has increased to greater than 100 beats per minute, and the baby has sustained spontaneous breathing. PreviousNext
Question 8 of 12 A full-term baby is born following an emergency cesarean delivery for non-reassuring fetal heart rate patterns. The baby is apneic at birth, despite tacti What is the single most important and effective step in resuscitation of this newborn? Answers istration of supplemental oxygen Providing additional tactile stimulation Chest compressions Ventilating the lungs PreviousNext Question 9 of 12 You are giving positive-pressure ventilation to a baby because he is apneic and bradycardic. What is the most important indicator of successful positive-pressure ventilation? Answers Improvement in tone and movement A rising heart rate Audible and bilateral breath sounds Chest rise with each breath PreviousNext Question 10 of 12 A full term newborn is apneic at birth and requires positive-pressure ventilation.
What concentration of oxygen should be used during resuscitation? Answers Room air may be used to start resuscitation of full-term newborns, with concentration adjusted based on the target oxygen saturation for the age in minu 40% to 60% oxygen should be used for resuscitation of full-term newborns, independent of color or oxygen saturation. Room air should be used for resuscitation of full-term newborns, independent of color or oxygen saturation. 100 % oxygen should be used if the baby is a full-term newborn, independent of color or oxygen saturation.
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Question 11 of 12 A baby is born in the hospital lobby as his mother waited for ission. He is apneic, despite tactile stimulation, drying, and bulb suctioning. You have What should your next step be? Answers Start positive-pressure ventilation using room air, and transport the baby to a care area. Call for someone to bring a 100% oxygen tank and oximeter to the patient before starting positive-pressure ventilation. Quickly transport the baby to a care area, and start positive-pressure ventilation with blended oxygen and monitor with an oximeter. Monitor the heart rate; if it slows, begin positive-pressure ventilation with room air. PreviousNext Question 12 of 12 A baby is noticed to have unusual breathing after birth. Which finding is an indication for using positive-pressure ventilation? Answers Chest asymmetry Marked tachypnea Apnea or gasping Grunting and retractions Previous
Lesson 4: Chest Compressions Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 Which is the appropriate position on this baby to apply chest compressions? Answers A C B D Next
Question 2 of 12 A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute. What is your next action? Answers Stop both chest compressions and positive-pressure ventilation. Continue chest compressions and positive-pressure ventilation. Stop chest compressions; continue positive-pressure ventilation.
ister epinephrine while continuing chest compressions and positive-pressure ventilation. PreviousNext Question 3 of 12 What is the preferred technique for chest compressions? Answers 2-thumb technique 2-finger technique Fist technique Heel-of-hand technique PreviousNext Question 4 of 12 When are chest compressions indicated? Answers Whenever the heart rate is less than 60 beats per minute When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation Whenever the heart rate is less that 100 beats per minute PreviousNext Question 5 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers remain in with the chest at all times. Ventilate whenever possible. 2:1 ratio of compressions to breaths is being used. Compression depth is one fourth the diameter of the chest. PreviousNext
Question 6 of 12 A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos seconds. What should the next step in the resuscitation process should be? Answers Provide free-flow oxygen, and begin initiating chest compressions. Continue stimulating the baby for an additional 30 seconds. Provide positive-pressure ventilation for at least 30 seconds. Initiate chest compressions using the 2-thumb technique. PreviousNext Question 7 of 12 Which of the following is a potential danger of istering chest compressions? Answers Gaseous distension of the stomach and intestinal tract Traumatizing the spinal column Providing excessive blood flow to vital organs Fracturing ribs or injuring the liver PreviousNext Question 8 of 12 Your team begins istering chest compressions to a newborn.
Correct technique includes which of the following? Answers Thumbs or fingers are lifted off the chest during the relaxation phase. Compression depth is one-fourth the diameter of the chest. Chest compressions and ventilation are well coordinated. A 2:1 ratio of compressions to breaths is being used. PreviousNext
Question 9 of 12 A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch What do you do next? Answers Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate. Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes. Increase oxygen concentration to ensure that the baby is well oxygenated. Decrease oxygen concentration and discontinue pulse oximetry monitoring. PreviousNext Question 10 of 12 When chest compressions are indicated, you should also consider: Answers Immediately istering epinephrine Increasing the temperature setting of the radiant warmer Endotracheal intubation, if not already done Repositioning the baby’s head PreviousNext Question 11 of 12 When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? Answers 30 breaths, 90 compressions 60 breaths, 120 compressions 60 breaths, 60 compressions 40 breaths, 80 compressions PreviousNext Question 12 of 12 What is the ideal depth of chest compressions for a newborn? Answers One fourth the antero-posterior diameter of the chest Half the antero-posterior diameter of the chest One third the antero-posterior diameter of the chest Two thirds the antero-posterior diameter of the chest. Previous Lesson 4: Chest Compressions Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window.
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Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 Which is the appropriate position on this baby to apply chest compressions? Answers A C B D Next
Question 2 of 12 A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute. What is your next action? Answers Stop both chest compressions and positive-pressure ventilation. Continue chest compressions and positive-pressure ventilation. Stop chest compressions; continue positive-pressure ventilation. ister epinephrine while continuing chest compressions and positive-pressure ventilation. PreviousNext Question 3 of 12 What is the preferred technique for chest compressions? Answers 2-thumb technique 2-finger technique Fist technique Heel-of-hand technique PreviousNext Question 4 of 12 When are chest compressions indicated? Answers Whenever the heart rate is less than 60 beats per minute When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation Whenever the heart rate is less that 100 beats per minute PreviousNext Question 5 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers remain in with the chest at all times. Ventilate whenever possible. 2:1 ratio of compressions to breaths is being used. Compression depth is one fourth the diameter of the chest. PreviousNext
Question 6 of 12 A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos seconds.
What should the next step in the resuscitation process should be? Answers Provide free-flow oxygen, and begin initiating chest compressions. Continue stimulating the baby for an additional 30 seconds. Provide positive-pressure ventilation for at least 30 seconds. Initiate chest compressions using the 2-thumb technique. PreviousNext Question 7 of 12 Which of the following is a potential danger of istering chest compressions? Answers Gaseous distension of the stomach and intestinal tract Traumatizing the spinal column Providing excessive blood flow to vital organs Fracturing ribs or injuring the liver PreviousNext Question 8 of 12 Your team begins istering chest compressions to a newborn. Correct technique includes which of the following? Answers Thumbs or fingers are lifted off the chest during the relaxation phase. Compression depth is one-fourth the diameter of the chest. Chest compressions and ventilation are well coordinated. A 2:1 ratio of compressions to breaths is being used. PreviousNext
Question 9 of 12 A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch What do you do next? Answers Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate. Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes. Increase oxygen concentration to ensure that the baby is well oxygenated. Decrease oxygen concentration and discontinue pulse oximetry monitoring. PreviousNext Question 10 of 12 When chest compressions are indicated, you should also consider: Answers Immediately istering epinephrine Increasing the temperature setting of the radiant warmer Endotracheal intubation, if not already done Repositioning the baby’s head PreviousNext Question 11 of 12 When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute? Answers 30 breaths, 90 compressions 60 breaths, 120 compressions 60 breaths, 60 compressions 40 breaths, 80 compressions
PreviousNext Question 12 of 12 What is the ideal depth of chest compressions for a newborn? Answers One fourth the antero-posterior diameter of the chest Half the antero-posterior diameter of the chest One third the antero-posterior diameter of the chest Two thirds the antero-posterior diameter of the chest. Previous Lesson 5: Endotracheal Intubation and Laryngeal Mask Airway Insertion Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth we Answers 2.5 mm 3.0 mm 2.0 mm 3.5 mm Next Question 2 of 12 You are uncertain whether you have successfully intubated a newborn. Which of the following is an indication that the endotracheal tube is correctly placed in the trachea, and not in the esophagus? Answers Continued cyanosis and bradycardia. Air is heard entering the stomach. No vapor (mist) is detected in the endotracheal tube. Carbon dioxide detector indicates the presence of expired carbon dioxide. PreviousNext
Question 3 of 12 A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of bag-and-mask ventilation. Your team plans to intubate. Which
Question 5 of 12 You are part of a team resuscitating a baby who has meconium-stained fluid. A person experienced in endotracheal intubation should be Answers Called in from home when a baby is born and requires intubation. Immediately available to the resuscitation team to assist at every delivery.
Not necessary if another team member knows how to place a laryngeal mask airway. Called from an office near the hospital. PreviousNext Question 6 of 12 What is the approximate period within which one should ideally be able to intubate a newborn? Answers 60 seconds 30 seconds 40 seconds 20 seconds PreviousNext Question 7 of 12 You have successfully intubated a newborn with an estimated 35-week gestational age newborn and an estimated birth weight of 2 kg. What is the correct tip-to-lip depth of tube insertion for correct placement in the mid-trachea? Answers 6 cm 7 cm 9 cm 8 cm PreviousNext Question 8 of 12 Which of the following is an indication for intubation? Answers The presence of thick meconium in a vigorous newborn who must be suctioned The need to ister continuous positive airway pressure The need for positive-pressure ventilation lasting beyond a few minutes An estimated gestational age of less than 28 weeks PreviousNext Question 9 of 12 What size (internal diameter) endotracheal tube should you use when intubating a newborn of 30 weeks’ gestation with a birth weight of 1,200 g? Answers 3.0 mm 2.5 mm 4.0 mm 3.5 mm PreviousNext Question 10 of 12 What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks (estimated birth weight of 1,200 g)? Answers 2 00 0 1 PreviousNext Question 11 of 12 You are practicing the use of an algorithm to direct the sequence of interventions to correct ventilation. In which situation will the placement of a laryngeal mask airway be useful?
Answers When a term newborn with thick meconium has respiratory depression at birth When positive-pressure ventilation with a face mask fails to achieve effective ventilation and intubation is not possible When a newborn has facial or upper airway malformations and is breathing comfortably When a 30-week preterm newborn requires surfactant in the delivery room PreviousNext
Question 12 of 12 What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 38 weeks and an estimated birth weight of 3200 Answers 1 00 0 2 Previous Lesson 6: Medications Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 During resuscitation, one of your team suggests that the baby might benefit from a bolus of fluid. Which of the following is an indication for volume expansion during resuscitation? Answers The baby’s heart rate is 110 after resuscitative efforts and there is a history of extensive vaginal bleeding during labor The baby’s heart rate is 120 after resuscitative efforts but she is very pale The baby’s heart rate remains 70 after resuscitative efforts and pulses are weak The baby’s heart rate is increasing with resuscitative efforts but his pulses seem weak Next
Question 2 of 12 You are called to an emergency cesarean delivery of a 28-week gestational age baby because of prolonged rupture of membranes, chorioamnionitis, and the baby is non-vigorous with apnea, very poor tone, and a gray color. The baby appears to be about 1 kg. You place the newborn in plastic wrap, cover stimulate, but the baby remains apneic with a heart rate of 30 beats per minute. You initiate ventilation but have no improvement in heart rate or chest m pressure (MR SOPA). You quickly intubate, confirm appropriate endotracheal tube placement, and secure the tube. The heart rate continues to be 30 bea improvement in heart rate. You decide to ister epinephrine and a team member places an umbilical venous catheter. What dose of 1:10,000 concentration epinephrine will best result in return of spontaneous circulation? Answers 0.1 ml epinephrine via intravenous istration 0.5 ml epinephrine via endotracheal tube istration 0.5 ml epiephrine via intravenous istration 0.1 ml epinephrine via endotracheal tube istration PreviousNext
Question 3 of 12 A 32-week gestational age baby is delivered following 50% abruption and has not responded to the initial steps of resuscitation, 30 seconds of positive-p positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is istered. The epinephrine should be istered over the following timeframe
Answers Over 1 to 2 minutes Over 5 to 10 minutes Rapid push as quickly as possible Over 3 to 5 minutes PreviousNext Question 4 of 12 Which fluid is not a reasonable choice for volume expansion? Answers Ringer’s lactate Normal saline Placental blood drawn through umbilical vein O Rh-negative blood PreviousNext
Question 5 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to 60 seconds of cardiac compressions coordinated with positive pressure ventilation in a 3:1 ratio. You decide to ister intravenous epinephrine. Which vessel in the drawing should be used? Answers C B A PreviousNext
Question 6 of 12 You are called to an emergency cesarean delivery of a term baby due to a Category 3 fetal heart rate monitoring strip. At your request, additional help ha Despite repositioning, drying and stimulation, the newborn remains apneic with a heart rate of 30 beats per minute. You initiate ventilation and achieve and secure the tube. The heart rate is now 30 beats per minute, and a team member begins chest compressions. Together you provide 45 to 60 seconds o epinephrine via the endotracheal tube while another team member obtains IV access. What is the appropriate dose of 1:10,000 concentration of epinephrine for endotracheal delivery to a 3 kg baby? Answers 0.5 ml epinephrine via endotracheal tube 1.5 ml epinephrine via endotracheal tube 0.3 ml epinephrine via endotracheal tube 0.9 ml epinephrine via endotracheal tube PreviousNext Question 7 of 12 Which of the following medications may be used during the first several minutes of neonatal resuscitation? Answers Calcium Epinephrine Atropine Sodium bicarbonate PreviousNext
Question 8 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. An emergency umbilical venous catheter is placed. The catheter should be inserted
Answers Just as far as the length of the umbilical stump Two thirds of the shoulder-to-umbilical distance Just far enough to get blood return to a depth of 10 to 11 cm PreviousNext
Question 9 of 12 You are called to an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and late decelerations t meconium staining, and a gray color. You quickly intubate and suction for meconium; none is obtained below the cords. You then reposition the baby, dr What is the most appropriate next step of resuscitation? Answers Intubate and ister 0.05 mg/kg of endotracheal epinephrine. Start cardiac compressions coordinated 3:1 with ventilation. Initiate effective positive-pressure ventilation for 30 seconds and reassess the heart rate. Continue rubbing the back of the baby with a towel to increase stimulation. PreviousNext Question 10 of 12 How soon after delivery of epinephrine should you recheck the baby’s heart rate? Answers 1 minute 30 seconds 5 minutes 10 to 15 seconds PreviousNext
Question 11 of 12 A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to 60 seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is istered. What is the most important effect of epinephrine? Answers Increase heart rate via improved coronary perfusion pressure via its peripheral vasoconstrictive effects. Increase heart rate via increased chronotropy. Increase heart rate via increased inotropy. Increase heart rate via increased pulmonary vasoconstriction. PreviousNext
Question 12 of 12 If a newborn’s heart rate remains less than 60 beats per minute after positive-pressure ventilation and chest compressions, you should do all of the follow Answers Establish intravenous access for istration of epinephrine. Check to ensure that ventilation is producing adequate lung inflation, and cardiac compressions are being done correctly. ister sodium bicarbonate. ister subsequent epinephrine doses (if needed) in 3- to 5-minute intervals. Previous Lesson 7: Special Considerations Examination Summary • This examination contains 12 question(s).
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You must answer 80% correctly or 10 out of 12 question(s) in order to this examination. Use Next/Previous rather than the scroll bar.
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Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 12 While resuscitating a term newborn, you observe that the baby has severe respiratory distress and an unusually flat abdomen, with no air entry on the lef Which of the following is the most likely diagnosis? Answers Pierre Robin syndrome Pulmonary hypoplasia Left choanal atresia Congenital diaphragmatic hernia Next Question 2 of 12 During positive-pressure ventilation of a newborn, the breath sounds suddenly become inaudible on one side of the chest. Which of the following statements is true? Answers Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed superior In the delivery room, a pneumothorax should only be evacuated from the 4th intercostal space in the midclavicular line In the delivery room, a pneumothorax should only be evacuated from the 2nd intercostal space in the anterior axillary line Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed inferior PreviousNext Question 3 of 12 Which of the following are special steps necessary in the resuscitation of a newborn with suspected congenital diaphragmatic hernia? Answers with continuous positive airway pressure and a high oxygen concentration Endotracheal intubation and placement of an orogastric tube Bag-and-mask ventilation at a high rate with no end-expiratory pressure Bag-and-mask ventilation with high peak inspiratory pressure and high positive end-expiratory pressure PreviousNext Question 4 of 12 Which of the following is true about pneumothoraces in the newborn? Answers A chest radiograph must always be obtained prior to evacuating a pneumothorax The risk of pneumothorax is increased if positive-pressure ventilation is provided Pneumothoraces rarely complicate congenital diaphragmatic hernia Every pneumothorax requires immediate evacuation PreviousNext Question 5 of 12 A baby does not appear to be improving after intubation. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? Answers Laryngeal web Congenital goiter Pierre Robin syndrome Malpositioned endotracheal tube PreviousNext
Question 6 of 12 A baby under your care has severe respiratory distress after birth, but can be easily ventilated with positive-pressure ventilation by mask. How can you test for choanal atresia? Answers Place a carbon dioxide detector over each of the nares. Attempt to an endotracheal tube through each naris into the posterior pharynx. Obtain lateral skull radiographs to determine patency of the nares. Attempt to a suction catheter through each naris into the posterior pharynx. PreviousNext
Question 7 of 12 A 10-day-old, mechanically ventilated newborn suddenly develops bradycardia and low oxygen saturation, despite the oxygen concentration being incre What is the first and the most important step in the resuscitation of this newborn? Answers Begin chest compressions at a rate of 90 events per minute. Assess and establish adequate ventilation. ister 10 mL/kg normal saline bolus over 5 to 10 minutes. Obtain a 12-lead electrocardiogram. PreviousNext Question 8 of 12 Which of the following statements is true about the use of therapeutic hypothermia in a baby with hypoxic-ischemic encephalopathy? Answers The improvement in outcome from this therapy is directly related to the degree of hypothermia. Therapeutic hypothermia has been demonstrated to improve neurologic outcomes in newborns of all gestational ages. Therapeutic hypothermia is effective if initiated at any time within the first 24 hours. Therapeutic hypothermia requires specialized equipment, and should only be used according to well defined protocols. PreviousNext Question 9 of 12 A baby is unable to breath adequately after birth. Which of the following statements is true? Answers Severe pulmonary hypoplasia usually is incompatible with survival. Pulmonary hypoplasia is rarely associated with pneumothoraces. Pulmonary hypoplasia may result from any cause of polyhydramnios. Hypoplastic lungs are easily ventilated with low inflation pressures. PreviousNext
Question 10 of 12 Your team is resuscitating a preterm newborn. Positive-pressure ventilation with bag and mask has resulted in good bilateral air entry, normal heart rate, Which of the following is the most likely cause of ineffective respirations in this newborn? Answers Maternal treatment with terbutaline Maternal treatment with magnesium sulfate Pulmonary hypoplasia Congenital heart disease PreviousNext Question 11 of 12 ing the MR SOPA acronym helps your team correct problems with ventilation. Which of the following steps are included in MR SOPA? Answers
Mask seal ensured, Reposition head of baby, Suction the airway Mask seal ensured, Repeat stimulation, Suction the airway Mouth opened, Repeat stimulation, Saturation check Mouth opened, Reposition head, Saturation check PreviousNext Question 12 of 12 You have established a team to help care for a newborn with a known congenital heart defect. Which of the following statements is true for babies with major congenital heart disease? Answers These babies will have poor respiratory drive as a result of the heart disease. These babies will always have a heart murmur on exam at birth. These babies are rarely critically ill immediately following birth. The diagnosis of congenital heart disease in these babies can almost always be established in the delivery room. Previous
Lesson 8: Resuscitation of Babies Born Preterm Examination Summary • This examination contains 7 question(s).
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You must answer 80% correctly or 6 out of 7 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 7 You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby’s mother had a fever and chorioamnionitis. Resuscitation ha Which of the following is a true statement about the baby’s subsequent care? Answers Supplemental oxygen should be provided to maintain the baby’s oxygen saturation equal to or above 98%. Enteral feedings should be started immediately and advanced rapidly to ensure adequate nutrition. Antibiotics are not indicated because the risk of infection is low following preterm birth. Blood glucose levels should be monitored because glycogen stores may be rapidly depleted after resuscitation. Next
Question 2 of 7 You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby is 5 minutes old and breathing spontaneously. Heart rate is becoming labored. Which of the following is an appropriate action? Answers ister positive-pressure ventilation with an initial inflation pressure of 30 to 35 cm H 2O. Provide supplemental oxygen to rapidly increase the baby’s oxygen saturation above 95%. Provide vigorous stimulation on the back, trunk, and extremities. ister 5 to 6 cm H2O continuous positive airway pressure. PreviousNext Question 3 of 7 You have been called to attend the birth of a baby at 25 weeks’ gestation, with an estimated fetal weight of 750 g.
Which of the following is a true statement about the preparation and resources needed for this preterm birth? Answers A compressed air source, oxygen blender, and pulse oximeter should be in the room and available for immediate use. The delivery room temperature should be decreased to approximately 65ºF to 66ºF (18.3ºC to 18.8ºC) to avoid hyperthermia. A size 1 laryngoscope and size 3.5-mm endotracheal tube should be prepared for the initial intubation attempt, in the event that the baby has respiratory Personnel skilled in intubation and umbilical catheter placement may be on call at home or in another area of the hospital. PreviousNext Question 4 of 7 You have been called to attend the birth of a baby at 25 weeks’ gestation, with an estimated fetal weight of 750 g. Which of the following is a true statement about the complications that may occur in this extremely premature baby compared to a term newborn? Answers The baby’s body-surface area decreases heat loss and increases the risk of developing hyperthermia. The baby’s muscles and surfactant deficiency make effective spontaneous ventilation more difficult to achieve. The baby’s underdeveloped lungs are less likely to be injured by positive-pressure ventilation and high concentrations of oxygen. The lack of blood vessel development in the baby’s brain decreases the risk of developing intracranial bleeding. PreviousNext Question 5 of 7 What resources are needed to prepare for a preterm birth? Answers Additional means to maintain body temperature should be prepared, such as reclosable polyethylene bags and a portable warming pad. All of these. Additional trained personnel should be requested, including someone with expertise performing endotracheal intubation. A pulse oximeter and an oxygen blender should be available in the delivery room. PreviousNext
Question 6 of 7 You are in the delivery room caring for a preterm newborn at 28 weeks’ gestation. The baby was intubated for poor respiratory effort, and you are provid oximeter on the right wrist; after 10 minutes, oxygen saturation is 80% and not rising. Which of the following is an appropriate action? Answers Increase the oxygen concentration. Ventilate without positive end-expiratory pressure. Move the pulse oximeter to the baby’s left wrist. Insert an orogastric tube. PreviousNext Question 7 of 7 You recognize that premature newborns are vulnerable to hyperoxia and you have an oximeter and blender in your delivery room. What action is appropriate with this equipment during and immediately following resuscitation of babies born preterm? Answers Adjusting the inspired oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 5 to 10 minutes after birth. Relying on the oximeter saturation reading when the heart rate displayed on the oximeter is different from the heart rate you hear with a stethoscope. Turning up the inspired oxygen concentration if you note saturations of 70% to 80% during the first 2 minutes of life. Always initiating ventilation with 21% oxygen (0.21 FiO2) in such babies. Previous HhLesson 9: Ethics and Care at the End of Life Examination Summary • This examination contains 10 question(s).
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You must answer 80% correctly or 8 out of 10 question(s) in order to this examination. Use Next/Previous rather than the scroll bar. Do NOT click the X on the upper right-hand corner of the window. Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored. This assessment is not timed.
Question 1 of 10 A woman is itted at 24 weeks’ gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born within the ne
What is likely to be helpful in this process? Answers It is worth obtaining up-to-date outcome data for your institution or region, or using the Neonatal Resuscitation Program Web site and National Instutite It is best to wait until the mother has received some medications, such as magnesium sulfate or analgesics, as these often help relieve her anxiety and the The obstetrician and neonatologist should ideally meet separately with the parents, so the full range of perspectives and possibilities is most clear. Make sure you cover all material in one session because repeated discussions tend to increase anxiety and limit understanding. Next Question 2 of 10 You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability and whose birth is imminent.
What should you tell the parents when they ask you how decisions about resuscitation are made? Answers You offer to bring an ultrasonographer to the birth so that the baby can be immediately assessed for the presence of an intracranial hemorrhage, to guide The decision agreed to before birth may need to be modified based on the condition of the baby after birth and the postnatal gestational age assessment. You will categorically honor and follow whatever decision - to initiate or withhold resuscitation - you reach together prior to birth. While the parents are important people, only you and the other caregivers have the knowledge and ultimate responsibility to make decisions on resuscita PreviousNext Question 3 of 10 In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn? Answers The of the resuscitation team The delivering obstetrician The hospital chaplain The parents PreviousNext Question 4 of 10 You are called to the birth of a newborn weighing 385 g and gestational age of just under 23 weeks, a birth weight that is associated with almost certain Which action is appropriate? Answers Attempts at resuscitation are not indicated under these circumstances; care should focus on comfort alone. Attempts at resuscitation are indicated and expected if your team is called to a birth. Attempts at resuscitation can be delayed for up to five minutes to allow time to determine whether the baby might respond. Attempts at resuscitation should only be done after consultation with the hospital ethics committee. PreviousNext Question 5 of 10 Good decisions are based on good data. Which statement about obstetric dating and assessment is correct? Answers Fetal weight can not be estimated if there is intrauterine growth restriction. Dating can be reliably based on the ultrasound calculations of fetal weight. Techniques for dating are accurate to within 1 to 2 days, when they are performed in the second half of pregnancy. Techniques for obstetric dating are accurate to within 3 to 5 days, when assessed during the first trimester.
PreviousNext
Question 6 of 10 Which statement describes the ethical principle(s) that guide the resuscitation of a newborn? Answers The approach to decisions in the newborn should be guided by the same principles used for adults and older children. The decisions are the responsibility of the parent(s) and cannot be challenged by caregivers. The baby is a minor and any decisions on performing or discontinuing resuscitation should be made during an emergency meeting of the hospital ethics The ethical principles of beneficence, nonmaleficence, autonomy, and justice are used for adults and older children, but do not apply to newborns. PreviousNext Question 7 of 10 You are counseling a set of 17-year-old parents, whose baby is about to be born at 23 weeks’ gestation. You have explained that survival is unlikely and that everything be done, starting with resuscitation at birth. How might you answer them? Answers You explain that your first obligation is to do no harm and given the statistics, you will not begin resuscitation. You tell them you are glad they made this choice because federal law requires you to do this anyway. You assure them that as the parents, they are the appropriate voice for their baby and you will their wishes. You tell them that because they are younger than the legal voting age, they are not able to make final decisions and you will take that responsibility. PreviousNext
Question 8 of 10 You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks’ gestation. The newborn emerg monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with medications; fluids; and performance of chest compressions). After what duration of time might it be appropriate to discontinue resuscitative efforts? Answers After 10 minutes of no detectable heart rate (Asystole) After 5 minutes of no detectable heart rate (Asystole) After 20 minutes of no detectable heart rate (Asystole) After 30 minutes of no detectable heart rate (Asystole) PreviousNext
Question 9 of 10 In the course of planning care for a newborn with a known genetic disorder, one of your team suggests that no resuscitation be offered. The pa Which of the following statements is true? Answers Withdrawal or non-initiation of may be acceptable if there is agreement between parents and the treating team that this will be futile. It is better to withhold resuscitation because once you start, you are obligated to continue life . If the parents request no resuscitation, there is no situation in which a caregiver can legally go against their wishes United States federal law mandates resuscitation of all newborns regardless of underlying conditions PreviousNext Question 10 of 10 When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents Answers The resuscitation team alone will make the appropriate decision after birth. The hospital ethics committee must be consulted in order to make a decision. The option of only providing comfort care can be considered. No resuscitation will be started under any circumstances.
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