Preparation Flashcard 1
Rationale
B. Rationale: The scoop-and-run in which the newborn is carried and brought to an area with neonatal resuscitation equipment readily available is not recommended. The risk of a fall or other injury is great if you collide with a person, equipment, or a door. Therefore, the facility must design a maternal ward with resuscitation equipment within easy reach of healthcare providers. It may include a self-inflating bag for urgent PPV until a resuscitation team arrives, bringing additional equipment for initial stabilization and safe transfer to the NICU.
Question
A newborn male infant receives routine newborn care and is roomed in with his mother. After 30 minutes, the mother calls you because the baby is cyanotic with irregular breathing. You check the heart rate, and it is 45 bpm. What is your next course of action?
a. Pick up the baby and call for help while transferring the patient to a room with the necessary equipment and a resuscitation team on standby.
b. Call for help, get a bag-mask, and provide positive pressure ventilation while waiting for the resuscitation team.
c. Call for help and immediately perform chest compressions; defibrillate once the machine is attached to the patient.
d. Call for help and give intravenous epinephrine after providing 5 cycles of chest compressions while waiting for the resuscitation team to arrive.
Answer
b. Call for help, get a bag-mask, and provide positive pressure ventilation while waiting for the resuscitation team.
Rationale
D. Rationale: Thickly stained amniotic fluid indicates that there is a possibility of meconium aspiration, which can significantly block the airways. Suction catheters (size 10F or 12F) are needed to clear the airway. A meconium aspirator may be necessary as well. It is designed especially for clearing the airway from meconium aspiration. NRP no longer recommends repeated intubation and suction with the meconium aspirator. Current guidelines emphasize adherence to the same sequence of resuscitation events for all babies, including those with meconium aspiration.
Question
A newly born female infant at 40 weeks gestation is born apneic, cyanotic, and bradycardic, with no evidence of crying. When convening with the obstetrician before this delivery, it was reported that the amniotic fluid is thickly stained. Which one of the following instruments is necessary for this situation?
a. A bulb syringe
b. A Yank Auer suction catheter
c. A Foley catheter
d. A 10F or 12F suction catheter
Answer
d. A 10F or 12F suction catheter
Rationale
B. Rationale: There are many types of births that require resuscitative measures occurring in hospitals, and a problematic birth may happen at any time. Therefore, NRP recommends that a neonatal resuscitation team be present during every delivery.
Question
Aside from the birth team, which includes the obstetrician, pediatrician, and nurses, what other teams should be present at the delivery of a normal infant?
a. The gynecological team
b. The neonatal resuscitation team
c. The organ donation team
d. No other team is needed
Answer
b. The neonatal resuscitation team
Rationale
D. Rationale: The 3-lead ECG is an accurate and efficient device that can measure heart rate instantaneously by measuring the heart’s electrical activity. A newly born is often hypothermic during and right after delivery. The body compensates by constricting blood vessels in the extremities where a pulse oximeter is likely to be applied, which causes an underestimation of the pulse rate.
Question
In every resuscitation attempt, the heart rate must be continuously assessed. Which of the following is an effective method for measuring the newly born’s heart rate?
a. Palpating the pulse
b. Auscultating with a stethoscope
c. Pulse oximetry
d. 3-lead ECG
Answer
d. 3-lead ECG
Rationale
A. Rationale: The following are antepartum risk factors: gestational age < 36 weeks or > 41 weeks, preeclampsia or eclampsia, maternal hypertension, multiple gestation, fetal anemia, poly/oligohydramnios, fetal hydrops, fetal macrosomia, intrauterine growth restriction, congenital malformations, and lack of prenatal care.
Question
To determine if an infant is at increased risk for a resuscitation event, the neonatal resuscitation team leader must determine which of the following antepartum risk factors?
a. Preeclampsia
b. Incomplete maternal prenatal vaccination
c. Gestational age of 37 weeks
d. All of the above
Answer
a. Preeclampsia
Rationale
C. Rationale: The room temperature should be kept in the range of 23–25°C.
Question
To prevent hypotension in the newborn, what should the room temperature be?
a. 16–18 °C
b. 18–20 °C
c. 23–25 °C
d. 35–37 °C
Answer
c. 23–25 °C
Rationale
B. Rationale: The oxygen blender is used to adjust the oxygen concentration to maintain the patient’s oxygen saturation between 94% to 100%, which is the optimal level. Too low or too high oxygen saturation is not favored due to high morbidity and mortality.
Question
What is the function of this device for neonatal resuscitation (see image below)?
a. To adjust the rate of oxygen supplementation
b. To titrate oxygen concentration
c. To increase or decrease the patient’s flow of air
d. To suction secretions
Answer
b. To titrate oxygen concentration
Rationale
C. Rationale: After exchanging notes between the neonatal resuscitation team and the obstetrician and pediatrician, the team attends a pre-resuscitation team briefing, during which a team leader is assigned. This person must be experienced and have mastered all roles in neonatal resuscitation. The team leader then delegates the different tasks to the available personnel and assigns their roles. They construct a plan for the upcoming resuscitation and ensure the necessary instruments are prepared.
Question
What is the most critical action of a neonatal resuscitation team that should be performed before a high-risk delivery during which a team leader is assigned along with other member roles, and a listing is made of possible interventions needed?
a. Initial steps in neonatal resuscitation
b. Feedback
c. Pre-resuscitation team briefing
d. Birthing protocols
Answer
c. Pre-resuscitation team briefing
Rationale
A. Rationale: Laryngoscope blade No. 0 is specifically designed for the preterm newborn.
Question
What size laryngoscope blade is used for preterm newborns?
a. Blade No. 0
b. Blade No. 1
c. Blade No. 2
d. Blade No. 3
Answer
a. Blade No. 0
Rationale
D. Rationale: It is recommended to use a self-inflating bag, flow-inflating bag, or a T-piece resuscitator when providing positive pressure ventilation.
Question
Which equipment provides positive pressure ventilation?
a. Self-inflating bag-mask device
b. Flow-inflating bag
c. T-piece resuscitator
d. All of the above
Answer
d. All of the above