Principles II- Quiz 1
This quiz reviews the material on Neonatal anesthesia for Principles 2. Quizzes come mostly from notes, with some from the book.
- 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
Correct Answer
A. NeonateExplanation
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.Rate this question:
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- 2.
You are caring for a 5 week old today. How would you classify this kid?
- A.
Neonate
- B.
Infant
- C.
Child
- D.
Newborn
Correct Answer
B. InfantExplanation
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.Rate this question:
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- 3.
What is the total body water content of a premature baby?
- A.
90%
- B.
70%
- C.
80%
- D.
60%
Correct Answer
C. 80%Explanation
Premature babies have a higher water content compared to full-term babies due to their underdeveloped organs and higher surface area to body weight ratio. This is because water is lost through the skin more easily in premature babies. Therefore, the total body water content of a premature baby is 80%.Rate this question:
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- 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
Correct Answer
D. Decreased Right Ventricular ComplianceExplanation
Neonates have a higher right ventricular compliance compared to adults. This means that the right ventricle in neonates is more elastic and can expand more easily to accommodate blood flow. In contrast, adults have a lower right ventricular compliance, indicating that their right ventricle is less elastic and has a reduced ability to stretch. Therefore, the statement "Decreased Right Ventricular Compliance" is not true regarding the anatomic differences between neonates and adults.Rate this question:
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- 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
Correct Answer
A. 10 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
Correct Answer
B. Ductus Venosus -
- 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
Correct Answer
C. Foramen Ovale -
- 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
Correct Answer
D. Right Ventricle -
- 9.
A full-term infant delivered via a scheduled cesarean section may be at an increased risk for what?
- A.
Transient Tachypnea
- B.
Persistant Pulmonary Hypertension
- C.
Meconium Aspiration
- D.
Cesarean Infants are not at an increased for any complications.
Correct Answer
A. Transient Tachypnea -
- 10.
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
Correct Answer
B. Persistant Pulmonary Hypertension -
- 11.
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
Correct Answer
C. Increased FRC at birthExplanation
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.Rate this question:
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- 12.
General anesthesia inhibits nonshivering thermogenesis in infants.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 13.
What would be appropriate vital signs for 3 month old child in your care?
- A.
RR 62 HR 145 BP 76/40
- B.
RR 10 HR 62 BP 58/30
- C.
RR 22 HR 120 BP 135/ 82
- D.
RR 28 HR 130 BP 72/40
Correct Answer
D. RR 28 HR 130 BP 72/40 -
- 14.
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
Correct Answer
B. 0.14 mgExplanation
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.Rate this question:
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- 15.
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.
Correct Answer
D. May lead to HTN and rupture of intracerebral vessels.Explanation
An awake intubation is generally not recommended for premature neonates because it may lead to hypertension (HTN) and rupture of intracerebral vessels. Premature neonates have fragile blood vessels and their cerebral vasculature is not fully developed, making them more susceptible to complications such as HTN and vessel rupture. Therefore, it is safer to avoid awake intubation in this population to minimize the risk of these potentially serious complications.Rate this question:
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- 16.
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.
Correct Answer
A. A child with pyloric stenosis who has been persistently vomitting -
- 17.
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.
Correct Answer
B. Through metabolism of brown fat. -
- 18.
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%
Correct Answer
C. Lidocaine 7.5 mg IV -
- 19.
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
Correct Answer
D. When the child is attempting to cry, grab tube and their eyes are open -
- 20.
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
Correct Answer
A. 90 ml -
- 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
Correct Answer
C. 120 -
- 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
Correct Answer
D. Cisatracurium 4mg IVExplanation
ppt slide 49Rate this question:
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- 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.
Correct Answer
A. Administer Sux 2mg/kg IV -
- 24.
Reversal of agents should ALWAYS be given to neonates due to their tendency toward post-op apnea.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
ppt slide 54Rate this question:
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- 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.
Correct Answer
B. Because of the risk of retinopathy of prematurityExplanation
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.Rate this question:
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- 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
Correct Answer
C. Ketamine -
- 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
Correct Answer
B. Lower -
- 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
Correct Answer
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.
Correct Answer
A. Stimulate the angle of the jawExplanation
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.Rate this question:
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- 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.
Correct Answer
B. We will most likely keep her overnight on a pulse oximeter just to watch her. -
- 31.
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
Correct Answer
A. 3-3.5 -
- 32.
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
Correct Answer
B. Shunt procedure for hydrocephalus -
- 33.
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
Correct Answer
C. Cardiac Defects -
- 34.
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
Correct Answer
D. Congenital diaphragmatic Hernia -
- 35.
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.
Correct Answer
B. N2O is contraindicated in these cases, due to ability to expand the bowel in the chest. -
- 36.
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
Correct Answer
C. Gastroschisis -
- 37.
Which form of TEF is most common?
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
A. A -
- 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
Correct Answer
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.
Correct Answer
A. An NG tube should be inserted to decompress the stomach and decrease risk of aspirationExplanation
ppt slides 38 & 41, diagnosis can be made by the inablity to pass an NG tube... it can't get past the pouch.
A gastrostomy tube MAY be inserted but not an NG tube.Rate this question:
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- 40.
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
Correct Answer
C. Ketamine -
- 41.
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.
Correct Answer
D. The need for early and aggressive fluid therapy. -
- 42.
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.
Correct Answer
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. -
- 43.
Which of the following conditions recommends use of a caudal block?
- A.
Meningomyelocele
- B.
CVP placement
- C.
Pyloric Stenosis
- D.
Necrotizing Enterocolitis
Correct Answer
C. Pyloric StenosisExplanation
ppt slide 83Rate this question:
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- 44.
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
Correct Answer
D. Hypochloremia and Metabolic AlkalosisExplanation
Pyloric stenosis is a condition characterized by the narrowing of the pylorus, the opening between the stomach and the small intestine. This narrowing can lead to obstruction and vomiting. The excessive vomiting can cause a loss of stomach acid, leading to hypochloremia (low chloride levels) and metabolic alkalosis (increased pH in the blood). Hypochloremia occurs because chloride is lost along with the excessive vomiting, while metabolic alkalosis occurs due to the loss of stomach acid. Therefore, hypochloremia and metabolic alkalosis are commonly associated with pyloric stenosis.Rate this question:
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- 45.
Rapid sequence intubation is recommended for patients with pyloric stenosis.
- A.
True
- B.
False
Correct Answer
A. True -
- 46.
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
Correct Answer
B. Bupivacaine 0.25% 1.25 ml/kg -
- 47.
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…
- A.
Necrotizing Enterocolitis
- B.
Hydrocephalus
- C.
Patent Ductus Arteriosus
- D.
Bacterial Pneumonia
Correct Answer
C. Patent Ductus Arteriosus -
- 48.
After closure of a PDA, the patient suddenly becomes hypotensive. What is your immediate response to this?
- A.
Make the surgeon aware and ask him to remove retractors until patient BP returns to acceptable levels.
- B.
Administer fluid bolus of 10-15 ml/kg of NS or LR to augment volume
- C.
Give ephedrine 0.15 mg/kg to raise BP
- D.
Place the patient into trendelenburg position to increase venous return.
Correct Answer
B. Administer fluid bolus of 10-15 ml/kg of NS or LR to augment volumeExplanation
ppt slide 89Rate this question:
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- 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?
- A.
Standard Inhalational Induction
- B.
Cancel procedure until child is more stable
- C.
Rapid Sequence induction
- D.
Induce with vecuronium and fentanyl
Correct Answer
C. Rapid Sequence induction -
- 50.
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.
Correct Answer
D. Yes, this can be done.Explanation
ppt slide 100Rate this question:
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