Principles II- Quiz 1

77 Questions | Total Attempts: 127

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Neonatal Resuscitation Quizzes & Trivia

This quiz reviews the material on Neonatal anesthesia for Principles 2. Quizzes come mostly from notes, with some from the book.


Questions and Answers
  • 1. 
    You are caring for a child who is two weeks old. What would this kid be classified as?
    • A. 

      Neonate

    • B. 

      Infant

    • C. 

      Child

    • D. 

      Newborn

  • 2. 
    You are caring for a 5 week old today. How would you classify this kid?
    • A. 

      Neonate

    • B. 

      Infant

    • C. 

      Child

    • D. 

      Newborn

  • 3. 
    What is the total body water content of a premature baby?
    • A. 

      90%

    • B. 

      70%

    • C. 

      80%

    • D. 

      60%

  • 4. 
    Which of the following is not true regarding anatomic differences between neonates and adults?
    • A. 

      Anterior and Cephalad Larynx

    • B. 

      Long Epiglottis

    • C. 

      Narrow Nasal Passages

    • D. 

      Decreased Right Ventricular Compliance

  • 5. 
    You are caring for 1 month old Audrey today who is having repair of pyloric stenosis. She weighs 5 kg currently. What would be an appropriate IV intubating dose of sux for Audrey?
    • A. 

      10 mg

    • B. 

      7.5 mg

    • C. 

      5 mg

    • D. 

      20 mg

  • 6. 
    Which of the following allows oxygenated blood  coming from the umbilical vein to go directly into the inferior vena cava, bypassing the liver?
    • A. 

      Ductus Arteriosis

    • B. 

      Ductus Venosus

    • C. 

      Foramen Ovale

    • D. 

      Iliac Arteries

  • 7. 
    Which of the following allows oxygenated blood from the right side of the heart to pass into the left side circulation via a shunt located between the right and left atria?
    • A. 

      Ductus Arteriosus

    • B. 

      Ductus Venosus

    • C. 

      Foramen Ovale

    • D. 

      Pulmonary Artery

  • 8. 
    In fetal circulation, which side of the heart ejects more of the cardiac output?
    • A. 

      Left Atria

    • B. 

      Both are equal

    • C. 

      Left Ventricle

    • D. 

      Right Ventricle

  • 9. 
    You are caring for 3 day old Zach. During delivery he aspirated meconium into his trachea. He has needed respiratory support due to hypoxia.  Little Zach is currently in resp distress and about to be intubated.  When you auscultate his chest you hear a pansystolic murmur, indicating a patent ductus arteriosis. What is the most likely diagnosis for little Zach?
    • A. 

      Transient Tachypnea of the newborn

    • B. 

      Persistant Pulmonary Hypertension

    • C. 

      Hyperbilirubinemia

    • D. 

      Pneumonitis of infancy

  • 10. 
    Which of the following is not true regarding physiological differences of the neonate?
    • A. 

      Lower Lung Compliance

    • B. 

      Cardiac output dependent on Heart rate

    • C. 

      Increased FRC at birth

    • D. 

      Higher total body water content

  • 11. 
    General anesthesia inhibits nonshivering thermogenesis in infants.
    • A. 

      True

    • B. 

      False

  • 12. 
    What would be an appropriate pre-medication dose of atropine for a 5 month old child weighing 7 kg?               
    • A. 

      14 mg

    • B. 

      0.14 mg

    • C. 

      0.07 mg

    • D. 

      0.7 mg

  • 13. 
    What would be an appropriate premedication dose of Glycopyrrolate for a 3 month old child weighing 6 kg?
    • A. 

      0.12 mg

    • B. 

      1.2 mg

    • C. 

      0.06 mg

    • D. 

      0.6 mg

  • 14. 
    Why is an awake intubation generally not recommended for premature neonates?
    • A. 

      Can lead the reopening of the Forman Ovale

    • B. 

      Due to hyperactive vagal activity it will cause the premature infant to become bradycardic

    • C. 

      Due to size of the airway we are more likely to cause severe damage to the esoaphagus and vocal cords.

    • D. 

      May lead to HTN and rupture of intracerebral vessels.

  • 15. 
    Which of the following may be an indication for an awake intubation?
    • A. 

      A child with pyloric stenosis who has been persistently vomitting

    • B. 

      1 day old child born to a diabetic mother, weighing 13 lbs.

    • C. 

      A child born with hydrocephalus going in for emergent Shunt placement

    • D. 

      A newborn with Meningomyelocele going in for repair, NPO for 6 hours.

  • 16. 
    How do neonates control their temperature?
    • A. 

      By increasing SVR and HR to constrict peripheral vessels and direct blood to their core

    • B. 

      Through metabolism of brown fat.

    • C. 

      Through Shivering to generate heat and energy within tissues.

    • D. 

      All The Above.

  • 17. 
    Which drug would you give to a 5kg infant to blunt the physiologic response to awake intubation?
    • A. 

      Sux 10mg IV

    • B. 

      Glyco 0.05mg IV

    • C. 

      Lidocaine 7.5 mg IV

    • D. 

      Nitrous oxide 70%

  • 18. 
    Which of the following describes an appropriate time to extubate a 2 month old child?
    • A. 

      When the child is still drowsy, but maintaining an adequate RR and Todal Volume.

    • B. 

      When the child can lift their head off the bead for 5 seconds and grasp your finger.

    • C. 

      When the child begins to move, regardless of eye opening (babies just aren’t cooperative here)

    • D. 

      When the child is attempting to cry, grab tube and their eyes are open

  • 19. 
    You are the SRNA for a full term neonate who is going in today for repair of an omphalocele. The child weighs 4 kg, with a current HCT 55%. The doctor says to transfuse the baby if the HCT drops to 40%. What is the allowable blood loss for the full term neonate?
    • A. 

      90 ml

    • B. 

      110 ml

    • C. 

      50 ml

    • D. 

      185 ml

  • 20. 
    You are the SRNA for an 11 month old child today. They were a fullterm baby and now weigh 10kg. The child has been NPO for 6 hours and is having an atraumatic surgical procedure. How much fluid would you give TOTAL during the FIRST hour of the procedure?
    • A. 

      180

    • B. 

      160

    • C. 

      120

    • D. 

      40

  • 21. 
    You are the SRNA for an 11 month old child today. They were a fullterm baby and now weigh 10kg. The child has been NPO for 6 hours and is having an atraumatic surgical procedure. How much fluid would you give to this child TOTAL during the SECOND hour of the procedure? (fluid total just for 2nd hour, not for entirety of procedure)
    • A. 

      160

    • B. 

      180

    • C. 

      120

    • D. 

      40

  • 22. 
    Which drug is considered the muscle relaxant drug of choice for a normal, healthy neonate undergoing a minor cosmetic procedure  to separate webbed toes. The child weighs 8 kg.
    • A. 

      Sux 32 mg IM

    • B. 

      Rocuronium 8mg IV

    • C. 

      Pavulon 0.8 mg IV

    • D. 

      Cisatracurium 4mg IV

  • 23. 
    How would you treat laryngospasm in a 6 week old child?
    • A. 

      Administer Sux 2mg/kg IV

    • B. 

      Give racemic epinephrine treatment

    • C. 

      Give 100% Oxygen via facemask and apply jaw thrust

    • D. 

      Flick bottom of childs feet to stimulate vagal nerve.

  • 24. 
    Reversal of agents should ALWAYS be given to neonates due to their tendency toward post-op apnea.
    • A. 

      True

    • B. 

      False

  • 25. 
    Why would you not administer 100% oxygen to a premature infant?
    • A. 

      Because of their immature respiratory control center which will cause apnea if arterial O2 tension becomes too high

    • B. 

      Because of the risk of retinopathy of prematurity

    • C. 

      Because of the risk of causing the Ductus Arteriosis & Forman Ovale to reopen

    • D. 

      Because you don’t feel like it.

  • 26. 
    You are the SRNA for an infant having a correction of coarctation of the aorta. The child is very ill with questionable volume status, as the BP has been dropping. Which drug should you choose as your main anesthetic to induce this patient?
    • A. 

      Desflurane

    • B. 

      Propofol

    • C. 

      Ketamine

    • D. 

      Pancuronium

  • 27. 
    Is your MAC higher or lower in a neonate as compared to a 6 yr old child?
    • A. 

      Higher

    • B. 

      Lower

    • C. 

      Roughly Equal

  • 28. 
    You are SRNA for 2 month old Giovanni, you go to visit him in pre-op and see he has no IV currently. He is an otherwise healthy baby who is coming in to repair an umbilical hernia. When should you insert an IV on this infant?
    • A. 

      Immediately so you can give pre-op meds

    • B. 

      This child does need an IV for a minor procedure

    • C. 

      Give Midazolam PO and then start the IV before induction

    • D. 

      After induction when the patient is asleep, hunt for an IV

  • 29. 
    You have just extubated a 3 week old child and are on your way to PACU when you notice the childs respirations become very shallow. The child is wearing an O2 face mask already so what should be your first action?
    • A. 

      Stimulate the angle of the jaw

    • B. 

      Pick up the child and shake them

    • C. 

      Call for a crash cart and begin chest compressions

    • D. 

      Reintubate the child and take them to PACU to be extubated later.

  • 30. 
    You are the nurse for a premature child who was born at 30 weeks gestation. The child is now 5 months old and doing very well. They have come in today for a minor elective procedure and the childs mother asks you when the child will go home. What do you tell her?
    • A. 

      As soon as I wheel her out of the OR you can take her!

    • B. 

      We will most likely keep her overnight on a pulse oximeter just to watch her.

    • C. 

      We will watch her in the PACU for 2-3 hours after the procedure and then she may go home.

    • D. 

      NEVER!! She isn’t really expected to survive this. You may want to call Goodwill to take the crib now.

  • 31. 
    What type of regional anesthesia is most commonly performed in neonates?
    • A. 

      Epidural

    • B. 

      Nerve Blocks

    • C. 

      Spinal

    • D. 

      Caudal

  • 32. 
    What size ETT would you choose for a newborn full term baby?
    • A. 

      3-3.5

    • B. 

      2-2.5

    • C. 

      4-4.5

    • D. 

      None of above

  • 33. 
    Which of the following surgical procedures is not commonly performed in the first week of life?
    • A. 

      TE Fistula repair

    • B. 

      Shunt procedure for hydrocephalus

    • C. 

      Intestinal Obstruction Repair

    • D. 

      Omphalocele repair

  • 34. 
    In infants with CDH, what associated congenital anomaly contributes most to increased morbidity and mortality?
    • A. 

      CNS disorders

    • B. 

      GI Disorders

    • C. 

      Cardiac Defects

    • D. 

      GU disorders

  • 35. 
    You are in the delivery room with Mrs. Nypa when her new son is born.  Upon his birth it becomes obvious something is wrong. The baby becomes hypoxic shortly after birth, and his abdomen has a strange inward curve to it. You auscultate the babies lungs and hear what sound like bowel sounds. What do you think is wrong with this infant?
    • A. 

      Tracheoesophageal fistula

    • B. 

      Gastroschisis

    • C. 

      Pyloric Stenosis

    • D. 

      Congenital diaphragmatic Hernia

  • 36. 
    Which of the following is true regarding anesthetic management of a child with CDH?
    • A. 

      Due to abnormal gastric anatomy, NG tubes should NOT be placed prior to surgery.

    • B. 

      N2O is contraindicated in these cases, due to ability to expand the bowel in the chest.

    • C. 

      High levels of positive pressure are necessary to maintain oxygenation in hypoplastic lungs.

    • D. 

      The patient may easily be extubated immediately post-op when the pressure within the chest is relieved.

  • 37. 
    Which of the following is a herniation of the abdominal contents outside of the abdominal cavity that is not covered by a sac and is not associated with any other congenital anomalies?
    • A. 

      Omphalocele

    • B. 

      Congenital Diaphragmatic Hernia

    • C. 

      Gastroschisis

    • D. 

      Tracheoesophageal Fistula

  • 38. 
    You are caring for Baby Hannah today in the NICU. She came to the NICU shortly after birth. Her primary symptoms are that feeding causes her to choke, cough, and become cyanotic. These are hallmark symptoms of what congenital anamoly?
    • A. 

      Congenital Diaphraghmatic Hernia

    • B. 

      Intestinal Obstruction

    • C. 

      Gastroschisis

    • D. 

      Tracheoesophageal Fistula

  • 39. 
    Which of the following is not true regarding anesthetic considerations for children with TEF?
    • A. 

      An NG tube should be inserted to decompress the stomach and decrease risk of aspiration

    • B. 

      The ETT should be placed between the fistula and the carina

    • C. 

      Surgical retraction commonly causes a main stem bronchi to collapse, and the surgeon should redraw retractors.

    • D. 

      Post-op ventilation is considered the norm as patients are still at risk for complications.

  • 40. 
    What is the most serious complication associated with intestinal obstruction due to malrotation of the intestines?
    • A. 

      Aspiration Pneumonia

    • B. 

      Midgut Volvulus

    • C. 

      Metabolic Alkalosis

    • D. 

      Necrotizing Enterocolitis

  • 41. 
    You are the SRNA for a 3 day old child having surgery for intestinal obstruction. This patient is hypovolemic and you are worried this child may not tolerate anesthesia well. What is your agent of choice for this patient?
    • A. 

      Sevoflurane

    • B. 

      Etomidate

    • C. 

      Ketamine

    • D. 

      Propofol

  • 42. 
    When caring for infants having large abdominal surgeries(omphalocele, malrotation) one the  MOST important considerations during surgery is the need for…
    • A. 

      Positive pressure ventilation

    • B. 

      Antibiotic therapy to treat sepsis

    • C. 

      The need for deep sedation with VAA’s and adequate paralysis.

    • D. 

      The need for early and aggressive fluid therapy.

  • 43. 
    Which of the following is not true about anesthetic considerations  for a child with a menigomyelocele?               
    • A. 

      It is absolutely contraindicated for the patient to be positioned supine (even with a donut) for induction and intubation due to the risk of causing damage.

    • B. 

      No muscle relaxants should be used during surgery.

    • C. 

      No nitrous oxide should be used during surgery.

    • D. 

      Due to cerebral disease these patients are more prone to apnea and respiratory arrest post-op and should be monitored in a NICU.

  • 44. 
    For which procedure would it be safe to use N20 in your anesthetic plan of care?
    • A. 

      Repair of Meningomyelocele

    • B. 

      Shunt placement for Hydrocephalus

    • C. 

      Surgery for necrotizing Enterocolitis

    • D. 

      Correction of Congenital Diaphraghmatic hernia

  • 45. 
    Which of the following conditions recommends use of a caudal block?
    • A. 

      Meningomyelocele

    • B. 

      CVP placement

    • C. 

      Pyloric Stenosis

    • D. 

      Necrotizing Enterocolitis

  • 46. 
    Pyloric Stenosis is commonly associated with what fluid and electrolyte abnormalities?
    • A. 

      Hypovolemia and Metabolic Acidosis

    • B. 

      Hypernatremia and Respiratory Acidosis

    • C. 

      Hyperkalemia and Respiratory Alkalosis

    • D. 

      Hypochloremia and Metabolic Alkalosis

  • 47. 
    You are performing a caudal block for a patient going in for repair of pyloric stenosis. What do you choose as an appropriate dose of local anesthetic for this?
    • A. 

      Chloroprocaine 1% 0.75 ml/kg

    • B. 

      Bupivacaine 0.25% 1.25 ml/kg

    • C. 

      Lidocaine 2% 0.25 ml/kg

    • D. 

      Mepivacaine 1% 0.5 ml/kg

  • 48. 
    You are caring for baby Niko who has hydrocephalus and is going in for shunt placement today. Upon assessment of the child you find that this baby has been vomiting through the night, is lethargic, and has an increased systolic BP with slight bradycardia. The child has been NPO for 10 hours prior to scheduled procedure. With this knowledge what sort of induction would you choose for this child?
    • A. 

      Standard Inhalational Induction

    • B. 

      Cancel procedure until child is more stable

    • C. 

      Rapid Sequence induction

    • D. 

      Induce with vecuronium and fentanyl

  • 49. 
    You are the SRNA for baby Martha who is having a VP shunt placement for hydrocephalus. During your pre-op evaluation your find her to be awake and alert, pupils are normal size, and a regular respiratory rate and SBP. Her vital signs appear stable at the time. She has been NPO for 8 hours prior to procedure. Would it be safe to do an inhalational induction on baby Martha?
    • A. 

      Dude… seriously…. I have no clue.

    • B. 

      No, Rapid sequence must be done for hydrocephalus patients

    • C. 

      No, She should be induced with ketamine & vecuronium.

    • D. 

      Yes, this can be done.

  • 50. 
    Which of the following is not one of the three major concerns during CVP placement?
    • A. 

      Airway management

    • B. 

      Electrolyte Imbalances

    • C. 

      Pneumothorax

    • D. 

      Bleeding

  • 51. 
    One of the first signs of hypovolemia in a neonate is tachycardia.
    • A. 

      True

    • B. 

      False

  • 52. 
    In fetal circulation, Right Ventricular  blood is pumped into the Pulmonary artery. Because of high PVR, 95% of blood ejected from RV (60% O2 sat) is shunted across the __________  into the descending Aorta and back to the placenta & lower body.
    • A. 

      Aortic Coarctation

    • B. 

      Ductus Venosus

    • C. 

      Foramen Ovale

    • D. 

      Ductus Arteriosus

  • 53. 
    Due to shunting, the fetal pulmonary circulation receives _____ of cardiac output.
    • A. 

      20-25%

    • B. 

      5-10%

    • C. 

      30-40%

    • D. 

      80-85%

  • 54. 
    Upon autopsy, what percentage of adults are found to have a PFO?
    • A. 

      10%

    • B. 

      50%

    • C. 

      25%

    • D. 

      15%

  • 55. 
    At what point will there be functional closure of the Ductus Arteriosus?
    • A. 

      As soon as the infant is born and SVR increases

    • B. 

      At 2-4 weeks of age

    • C. 

      At 1-2 months of age

    • D. 

      At 1-8 days of age

  • 56. 
    How does the position of the larynx differ in full term Neonates, when compared to that of adults? (Check all that apply)
    • A. 

      More Anterior and Cephalad

    • B. 

      Located at level of C4

    • C. 

      Located at level of C3

    • D. 

      Floppy epiglottis

  • 57. 
    For the Neonate, Cardiac output is primarily dependent upon….
    • A. 

      Stroke Volume

    • B. 

      Systolic Blood Pressure

    • C. 

      Pulmonary Vascular Resistance

    • D. 

      Heart Rate

  • 58. 
    Which of the following is not true regarding pharmacologic differences in neonates?
    • A. 

      Neonates have decreased Volume of Distribution for H2O soluble drugs.

    • B. 

      Neonates have Immature Hepatic Biotransformation

    • C. 

      Neonates have decreased protein binding of drugs

    • D. 

      Neonates have immature renal function

  • 59. 
    You are the SRNA for a 3 week old baby today. In order to decrease hypothermia, which of the following actions would be appropriate?
    • A. 

      Keep the OR at 20 degrees celcius

    • B. 

      Place a cloth blanket under the infant during the procedure

    • C. 

      Use a fluid warmer to deliver IV fluids

    • D. 

      All the above

  • 60. 
    Neonates may have Formula up until _____ hours prior to induction.
    • A. 

      2-3

    • B. 

      6-8

    • C. 

      4-5

    • D. 

      10-12

  • 61. 
    You are doing a case today for a premature infant, your preceptor asks you how much oxygen you should administer  to prevent Retinopathy of prematurity. You swiftly tell her…
    • A. 

      100% O2

    • B. 

      30% O2

    • C. 

      However much is needed to keep a sat of 90-95 percent.

    • D. 

      You want to hypo-oxygenate the patient.

  • 62. 
    Congenital Diaphragmatic Hernia occurs in approximately 1 out of every how many births?
    • A. 

      1,000

    • B. 

      2,500

    • C. 

      10,000

    • D. 

      5,000

  • 63. 
    What is the mortality rate for CDH?
    • A. 

      40-50%

    • B. 

      20-30%

    • C. 

      5-10%

    • D. 

      70-75%

  • 64. 
    Pulmonary hypoplasia is associated with what congenital anomaly?
    • A. 

      Persistant pulmonary hypertension

    • B. 

      Congenital diaphragmatic hernia

    • C. 

      Omphalocele

    • D. 

      Pyloric Stenosis

  • 65. 
    Which other anomalies are commonly associated with Omphalocele? (check all that apply)
    • A. 

      Necrotizing Enterocolitis

    • B. 

      Trisomy 21

    • C. 

      CDH

    • D. 

      TEF

    • E. 

      Cardiac Malformations

  • 66. 
    Which of the following problems would not be a pre-op problem associated with Necrotizing Enterocolitis?
    • A. 

      Peritonitis

    • B. 

      Acute Abdomen

    • C. 

      Pulmonary Hypoplasia

    • D. 

      Metabolic Acidosis

  • 67. 
    An infant with an upper respiratory infection has a higher probability of….
    • A. 

      Vomitting

    • B. 

      Malnutrition

    • C. 

      Diarrhea

    • D. 

      SIDS

  • 68. 
    Which of the following physiological changes occurs in neonates?
    • A. 

      Increase Vd, Decrease ECF; therefore require higher loading dose

    • B. 

      Decrease LV compliance; therefore SV dependent

    • C. 

      Under developed NMJ with lower pseudocholinterase activity

    • D. 

      Developed sympathetic nervous system only without full baroreceptor functionality

  • 69. 
    Which of the following is an anatomical difference that is present in neonates?
    • A. 

      Omega shaped tongue

    • B. 

      Long Epiglottis

    • C. 

      Anterior esophagus and pharynx

    • D. 

      Long submental distance

  • 70. 
    When intubating the neonate, you should do all of the following except?
    • A. 

      Place a pillow at the occiput to achieve a sniffing position

    • B. 

      Place a roll at their neck/shoulder

    • C. 

      Use an uncuffed ETT

    • D. 

      Use cricoid pressure to displace anterior anatomy

  • 71. 
    You are mask ventilating a neonate you notice that it is getting progressively more difficult to ventilate. Both your sats and HR are quickly dropping, what is your most appropriate intervention?
    • A. 

      Attempt a blind intubation, forcefully pushing the ETT through the cords

    • B. 

      Use Sux 4-5 mg/kg IM stat

    • C. 

      Find IO access and give Sux 2-3 mg/kg

    • D. 

      Crank up the Isoflurane to bronchodilate

  • 72. 
    A neonate born to a diabetic mother is having surgery today and mom tells you that she was afraid of the baby becoming hypoglycemic and that she gave the baby a couple sips of formula 2 hours ago. What anesthetic plan will you employ?
    • A. 

      General or Regional

    • B. 

      Awake intubation

    • C. 

      RSI

    • D. 

      Either b or c

  • 73. 
    You are having a bad day and you are about to do a small procedure on a neonate. You decide to make your life easier you will use some short-acting Sux to facilitate your intubation. Which of the following statements is correct?
    • A. 

      Sux has the ability to cause severe bradycardia in peds and should be avoided unless an emergency

    • B. 

      Ok to use, make sure to increase your dose from 1-1.5 mg/kg to 2-3 mg/kg IV

    • C. 

      Do not use, Sux is contraindicated in neonates

    • D. 

      Ok to use the IM dose of 4-5 mg/kg because redistribution is quicker

  • 74. 
    Retinopathy of Prematurity:
    • A. 

      Is a Fibrovascular proliferation over the retina causing permanent blindless

    • B. 

      Is due to vasoconstricting effects of O2

    • C. 

      Is related to hyperoxygenation

    • D. 

      Is prevented by underoxygenating the neonate

  • 75. 
    Neonates are prone to hypothermia because:
    • A. 

      VAA inhibit thermoregulation of brown fat

    • B. 

      Layered, chubby skin has an increase BSA

    • C. 

      Increase TBW and ECF

    • D. 

      Convection and Conduction heat loss through cool OR’s

  • 76. 
    What is an appropriate ABG for an infant that is one hour old?
    • A. 

      PO2 50 PCO2 48 pH 7.2

    • B. 

      PO2 70 PCO2 35 pH 7.35

    • C. 

      PO2 85 PCO2 25 pH 7.5

    • D. 

      PO2 60 PCO2 50 pH 7.4

  • 77. 
    Comic Reflief:
    • A. 

      Yeeaaahh! Dinosaurs!!!

    • B. 

      Eewweeeee

    • C. 

      All the above.