Principles II- Quiz 1

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  • 1/78 Questions

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

    • Ductus Arteriosis
    • Ductus Venosus
    • Foramen Ovale
    • Iliac Arteries
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Principles II- Quiz 1 - Quiz
About This Quiz

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

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  • 2. 

    You are caring for a child who is two weeks old. What would this kid be classified as?

    • Neonate

    • Infant

    • Child

    • Newborn

    Correct Answer
    A. Neonate
    Explanation
    A child who is two weeks old would be classified as a neonate. The term "neonate" refers to a newborn baby who is within the first 28 days of life. This stage is characterized by the child's adaptation to life outside the womb and their vulnerability to various health risks. Therefore, "neonate" is the correct classification for a two-week-old child.

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  • 3. 

    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?

    • Congenital Diaphraghmatic Hernia

    • Intestinal Obstruction

    • Gastroschisis

    • Tracheoesophageal Fistula

    Correct Answer
    A. Tracheoesophageal Fistula
  • 4. 

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

    • Stroke Volume

    • Systolic Blood Pressure

    • Pulmonary Vascular Resistance

    • Heart Rate

    Correct Answer
    A. Heart Rate
    Explanation
    In neonates, cardiac output is primarily dependent upon heart rate. This is because the heart rate determines the number of times the heart contracts and pumps blood per minute. As neonates have a relatively small stroke volume (the amount of blood pumped out of the heart with each contraction), their cardiac output is mainly regulated by heart rate. Additionally, factors such as systolic blood pressure and pulmonary vascular resistance may also influence cardiac output, but they are not the primary determinants in neonates.

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  • 5. 

    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?

    • Ductus Arteriosus

    • Ductus Venosus

    • Foramen Ovale

    • Pulmonary Artery

    Correct Answer
    A. Foramen Ovale
  • 6. 

    General anesthesia inhibits nonshivering thermogenesis in infants.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    General anesthesia refers to the administration of drugs that induce a reversible loss of consciousness and sensation. Nonshivering thermogenesis is the process by which infants generate heat to maintain their body temperature. This process is inhibited by general anesthesia, meaning that infants under general anesthesia are unable to generate heat through nonshivering thermogenesis. Therefore, the statement "General anesthesia inhibits nonshivering thermogenesis in infants" is true.

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  • 7. 

    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?

    • Stimulate the angle of the jaw

    • Pick up the child and shake them

    • Call for a crash cart and begin chest compressions

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

    Correct Answer
    A. Stimulate the angle of the jaw
    Explanation
    Stimulating the angle of the jaw can help to stimulate the child's respiratory drive and increase their respirations. This action can be performed by gently tapping or rubbing the angle of the jaw, which can help to stimulate the nerves and muscles involved in breathing. It is a non-invasive intervention that can be quickly performed in order to address the shallow respirations and potentially prevent further complications.

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  • 8. 

    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?

    • Tracheoesophageal fistula

    • Gastroschisis

    • Pyloric Stenosis

    • Congenital diaphragmatic Hernia

    Correct Answer
    A. Congenital diaphragmatic Hernia
  • 9. 

    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?

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

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

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

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

    Correct Answer
    A. We will most likely keep her overnight on a pulse oximeter just to watch her.
  • 10. 

    Which of the following is not true regarding physiological differences of the neonate?

    • Lower Lung Compliance

    • Cardiac output dependent on Heart rate

    • Increased FRC at birth

    • Higher total body water content

    Correct Answer
    A. Increased FRC at birth
    Explanation
    Increased FRC at birth is not true regarding physiological differences of the neonate. FRC (Functional Residual Capacity) refers to the volume of air present in the lungs at the end of passive expiration. In neonates, FRC is actually lower at birth compared to adults due to their smaller lung size and higher lung compliance. As the lungs develop and mature, FRC gradually increases. Therefore, the statement that there is an increased FRC at birth is incorrect.

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  • 11. 

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

    • CNS disorders

    • GI Disorders

    • Cardiac Defects

    • GU disorders

    Correct Answer
    A. Cardiac Defects
  • 12. 

    Rapid sequence intubation is recommended for patients with pyloric stenosis. 

    • True

    • False

    Correct Answer
    A. True
  • 13. 

    Which of the following is not one of the three major concerns during CVP placement?

    • Airway management

    • Electrolyte Imbalances

    • Pneumothorax

    • Bleeding

    Correct Answer
    A. Electrolyte Imbalances
    Explanation
    During CVP placement, the three major concerns are airway management, pneumothorax, and bleeding. Electrolyte imbalances are not directly related to the placement of a central venous catheter.

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  • 14. 

    In fetal circulation, which side of the heart ejects more of the cardiac output?

    • Left Atria

    • Both are equal

    • Left Ventricle

    • Right Ventricle

    Correct Answer
    A. Right Ventricle
  • 15. 

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

    • Neonate

    • Infant

    • Child

    • Newborn

    Correct Answer
    A. Infant
    Explanation
    The correct answer is "Infant" because at 5 weeks old, the child is no longer considered a newborn. The term "neonate" refers to a baby within the first 4 weeks of life, so it does not apply in this case. The term "child" is typically used for older children, so it is not appropriate for a 5-week-old. Therefore, "infant" is the most accurate classification for this age group.

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  • 16. 

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

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

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

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

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

    Correct Answer
    A. When the child is attempting to cry, grab tube and their eyes are open
  • 17. 

    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?

    • Transient Tachypnea of the newborn

    • Persistant Pulmonary Hypertension

    • Hyperbilirubinemia

    • Pneumonitis of infancy

    Correct Answer
    A. Persistant Pulmonary Hypertension
  • 18. 

    What would be appropriate vital signs for 3 month old child in your care?

    • RR 62 HR 145 BP 76/40

    • RR 10 HR 62 BP 58/30

    • RR 22 HR 120 BP 135/ 82

    • RR 28 HR 130 BP 72/40

    Correct Answer
    A. RR 28 HR 130 BP 72/40
  • 19. 

    Why would you not administer 100% oxygen to a premature infant?

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

    • Because of the risk of retinopathy of prematurity

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

    • Because you don’t feel like it.

    Correct Answer
    A. Because of the risk of retinopathy of prematurity
    Explanation
    Administering 100% oxygen to a premature infant can increase the risk of retinopathy of prematurity. This condition is characterized by abnormal blood vessel growth in the retina, which can lead to vision problems or even blindness. High levels of oxygen can contribute to the development or worsening of retinopathy of prematurity. Therefore, it is important to carefully monitor and control the oxygen levels given to premature infants to prevent this complication.

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  • 20. 

    Comic Reflief:

    • Yeeaaahh! Dinosaurs!!!

    • Eewweeeee

    • All the above.

    Correct Answer
    A. All the above.
    Explanation
    The answer "All the above" is correct because the given text includes the phrases "Yeeaaahh! Dinosaurs!!!" and "Eewweeeee," indicating excitement and disgust respectively. Since the question asks for an explanation for the correct answer, it can be inferred that the answer encompasses both emotions expressed in the text.

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  • 21. 

    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?

    • Desflurane

    • Propofol

    • Ketamine

    • Pancuronium

    Correct Answer
    A. Ketamine
  • 22. 

    When intubating the neonate, you should do all of the following except?

    • Place a pillow at the occiput to achieve a sniffing position

    • Place a roll at their neck/shoulder

    • Use an uncuffed ETT

    • Use cricoid pressure to displace anterior anatomy

    Correct Answer
    A. Place a pillow at the occiput to achieve a sniffing position
    Explanation
    Placing a pillow at the occiput to achieve a sniffing position is not a step that should be done when intubating a neonate. The sniffing position is a technique used to align the airway axis and improve visualization during intubation. It involves extending the head and flexing the neck. Placing a pillow at the occiput would counteract this positioning and hinder the intubation process. Therefore, it should not be done.

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  • 23. 

    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?

    • Sevoflurane

    • Etomidate

    • Ketamine

    • Propofol

    Correct Answer
    A. Ketamine
  • 24. 

    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?

    • Immediately so you can give pre-op meds

    • This child does need an IV for a minor procedure

    • Give Midazolam PO and then start the IV before induction

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

    Correct Answer
    A. After induction when the patient is asleep, hunt for an IV
  • 25. 

    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?

    • Omphalocele

    • Congenital Diaphragmatic Hernia

    • Gastroschisis

    • Tracheoesophageal Fistula

    Correct Answer
    A. Gastroschisis
  • 26. 

    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.

    • Aortic Coarctation

    • Ductus Venosus

    • Foramen Ovale

    • Ductus Arteriosus

    Correct Answer
    A. Ductus Arteriosus
    Explanation
    In fetal circulation, the right ventricle pumps blood into the pulmonary artery. However, due to the high pulmonary vascular resistance (PVR), a significant amount of the blood (95%) that is ejected from the right ventricle is shunted across the ductus arteriosus into the descending aorta. This allows the blood to bypass the lungs and flow back to the placenta and lower body for oxygenation. Therefore, the correct answer is Ductus Arteriosus.

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  • 27. 

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

    • 14 mg

    • 0.14 mg

    • 0.07 mg

    • 0.7 mg

    Correct Answer
    A. 0.14 mg
    Explanation
    Atropine is a medication commonly used to treat certain medical conditions. The appropriate dose of atropine for a 5-month-old child weighing 7 kg would be 0.14 mg. This dosage is based on the weight of the child and is calculated to ensure the medication is safe and effective for their size. It is important to carefully calculate and administer the correct dose of medication to avoid any potential harm or adverse effects.

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  • 28. 

    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?

    • Dude… seriously…. I have no clue.

    • No, Rapid sequence must be done for hydrocephalus patients

    • No, She should be induced with ketamine & vecuronium.

    • Yes, this can be done.

    Correct Answer
    A. Yes, this can be done.
    Explanation
    ppt slide 100

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  • 29. 

    In fetal circulation the ____ is relatively high while the ____ is relatively low, though this changes upon birth of the child.

    • PVR, SVR

    • SVR, PVR

    • HCT, HgB

    • HgB, HCT

    Correct Answer
    A. PVR, SVR
  • 30. 

    How do neonates control their temperature?

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

    • Through metabolism of brown fat.

    • Through Shivering to generate heat and energy within tissues.

    • All The Above.

    Correct Answer
    A. Through metabolism of brown fat.
  • 31. 

    Which of the following is true regarding anesthetic management of children with hydrocephalus?               

    • Patients with elevated ICP should be hyperventilated to an ETCO2 of 28-33.

    • Patients with elevated ICP should be positioned supine during the procedure.

    • Opioids are recommended to help control ventilations,since spontaneous ventilations are encouraged.

    • Anesthesia should be maintained with Propofol and Rocuronium.

    Correct Answer
    A. Patients with elevated ICP should be hyperventilated to an ETCO2 of 28-33.
  • 32. 

    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?

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

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

    • Do not use, Sux is contraindicated in neonates

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

    Correct Answer
    A. Sux has the ability to cause severe bradycardia in peds and should be avoided unless an emergency
  • 33. 

    Which of the following is not true regarding pharmacologic differences in neonates?

    • Neonates have decreased Volume of Distribution for H2O soluble drugs.

    • Neonates have Immature Hepatic Biotransformation

    • Neonates have decreased protein binding of drugs

    • Neonates have immature renal function

    Correct Answer
    A. Neonates have decreased Volume of Distribution for H2O soluble drugs.
    Explanation
    Neonates have a larger volume of distribution for water-soluble drugs compared to adults. This is because neonates have a higher proportion of total body water compared to adults. Due to their higher water content, water-soluble drugs distribute more widely in neonates, resulting in a larger volume of distribution. This is in contrast to lipid-soluble drugs, which have a smaller volume of distribution in neonates due to their lower proportion of fat compared to adults. Therefore, the statement that neonates have decreased volume of distribution for water-soluble drugs is not true.

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  • 34. 

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

    • Peritonitis

    • Acute Abdomen

    • Pulmonary Hypoplasia

    • Metabolic Acidosis

    Correct Answer
    A. Pulmonary Hypoplasia
    Explanation
    Pulmonary hypoplasia refers to underdevelopment of the lungs, which is not directly associated with necrotizing enterocolitis (NEC). NEC is a condition characterized by inflammation and tissue death in the intestines, commonly seen in premature infants. Pre-op problems associated with NEC typically include peritonitis, acute abdomen, and metabolic acidosis, which are all related to the gastrointestinal system. Pulmonary hypoplasia, on the other hand, is a separate condition that affects lung development and is not directly linked to NEC.

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  • 35. 

    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?

    • 10 mg

    • 7.5 mg

    • 5 mg

    • 20 mg

    Correct Answer
    A. 10 mg
  • 36. 

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

    • Sux 10mg IV

    • Glyco 0.05mg IV

    • Lidocaine 7.5 mg IV

    • Nitrous oxide 70%

    Correct Answer
    A. Lidocaine 7.5 mg IV
  • 37. 

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

    • Positive pressure ventilation

    • Antibiotic therapy to treat sepsis

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

    • The need for early and aggressive fluid therapy.

    Correct Answer
    A. The need for early and aggressive fluid therapy.
  • 38. 

    Why is Fetal Ion Trapping a concern for us?

    • When CO2 becomes trapped in less compliant neonatal lungs, this can lead to acidosis

    • When fetal blood breaks down, ion trapping will lead to a physiologic anemia

    • When giving a pregnant mother an opioid or local anesthetic these drugs may accumulate in fetal circulation causing fetal asphyxia and signs of overdose upon delivery.

    • Pregnant women may have severe electrolyte abnormalities due to the fetus ‘trapping’ vital nutrients within its circulation to sustain life.

    Correct Answer
    A. When giving a pregnant mother an opioid or local anesthetic these drugs may accumulate in fetal circulation causing fetal asphyxia and signs of overdose upon delivery.
  • 39. 

    A full-term infant delivered via a scheduled cesarean section may be at an increased risk for what?

    • Transient Tachypnea

    • Persistant Pulmonary Hypertension

    • Meconium Aspiration

    • Cesarean Infants are not at an increased for any complications.

    Correct Answer
    A. Transient Tachypnea
  • 40. 

    Neonates are prone to hypothermia because:

    • VAA inhibit thermoregulation of brown fat

    • Layered, chubby skin has an increase BSA

    • Increase TBW and ECF

    • Convection and Conduction heat loss through cold OR’s

    Correct Answer
    A. VAA inhibit thermoregulation of brown fat
    Explanation
    Neonates are prone to hypothermia because volatile anesthetic agents (VAA) inhibit the thermoregulation of brown fat. Brown fat is responsible for generating heat in the body, and when its thermoregulation is inhibited, the neonate's ability to maintain body temperature is compromised. This can lead to hypothermia, as the body is unable to generate enough heat to keep warm.

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  • 41. 

    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?

    • Chloroprocaine 1% 0.75 ml/kg

    • Bupivacaine 0.25% 1.25 ml/kg

    • Lidocaine 2% 0.25 ml/kg

    • Mepivacaine 1% 0.5 ml/kg

    Correct Answer
    A. Bupivacaine 0.25% 1.25 ml/kg
  • 42. 

    What size ETT would you choose for a newborn full term baby?

    • 3-3.5

    • 2-2.5

    • 4-4.5

    • None of above

    Correct Answer
    A. 3-3.5
  • 43. 

    You caring for baby Noah in the NICU today. When you examine him you find that he is tachypnic, has bounding pulses, a continuous murmur, and you are able to palpate hepatomegally in his abdomen. This is consistent with his current diagnosis of…

    • Necrotizing Enterocolitis

    • Hydrocephalus

    • Patent Ductus Arteriosus

    • Bacterial Pneumonia

    Correct Answer
    A. Patent Ductus Arteriosus
  • 44. 

    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)

    • 160

    • 180

    • 120

    • 40

    Correct Answer
    A. 120
  • 45. 

    How would you treat laryngospasm in a 6 week old child?

    • Administer Sux 2mg/kg IV

    • Give racemic epinephrine treatment

    • Give 100% Oxygen via facemask and apply jaw thrust

    • Flick bottom of childs feet to stimulate vagal nerve.

    Correct Answer
    A. Administer Sux 2mg/kg IV
  • 46. 

    After closure of a PDA, the patient suddenly becomes hypotensive. What is your immediate response to this?

    • Make the surgeon aware and ask him to remove retractors until patient BP returns to acceptable levels.

    • Administer fluid bolus of 10-15 ml/kg of NS or LR to augment volume

    • Give ephedrine 0.15 mg/kg to raise BP

    • Place the patient into trendelenburg position to increase venous return.

    Correct Answer
    A. Administer fluid bolus of 10-15 ml/kg of NS or LR to augment volume
    Explanation
    ppt slide 89

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  • 47. 

    Which of the following may be an indication for an awake intubation?

    • A child with pyloric stenosis who has been persistently vomitting

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

    • A child born with hydrocephalus going in for emergent Shunt placement

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

    Correct Answer
    A. A child with pyloric stenosis who has been persistently vomitting
  • 48. 

    Which of the following is true regarding anesthetic management of a child with CDH?

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

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

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

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

    Correct Answer
    A. N2O is contraindicated in these cases, due to ability to expand the bowel in the chest.
  • 49. 

    You are caring for baby Niko who has hydrocephalus  and is going in for a 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 schedules procedure. With this knowledge what sort of induction would you choose for this child?

    • Standard Inhalational Induction

    • Cancel procedure until child is more stable

    • Rapid Sequence induction

    • Induce with vecuronium and fentanyl

    Correct Answer
    A. Rapid Sequence induction

Quiz Review Timeline (Updated): Mar 21, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 24, 2009
    Quiz Created by
    Scottishduffy

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