OrientationTest: NICU EXPERIENCED Staff There are 51 questions on this test.  A score of 80% is required to be successful;  no more than 10 questions may be incorrect.  Good Luck!! First name:   Last name:   Title   Street   City, State, Zip Code   Phone   Email address     1 Apnea is defined as: Lasting longer than 20 seconds with bradycardia, hypoglycemia & cyanosis Lasting longer than 20 seconds with tachycardia, hypotonia & cyanosis Lasting longer than 20 seconds with bradycardia, hypotonia & cyanosis Lasting longer than 20 seconds with tachycardia, hypertonia & cyanosis 2 The endotracheal medication given to prevent or minimize RDS is: Caffeine Citrate Theophylline Dexamethasone Survanta 3 Oxygen dependency after 28 days of age might indicate what pulmonary disease? Cor Pulmonale Neonatal apnea Pulmonary hypertension Bronchopulmonary Dysplasia 4 Your infant has a documented polycythemia.  Polycythemia is defined as: A central hematocrit of < 45% A peripheral hematocrit of < 45% A central hematocrit of > 65% a peripheral hematocrit of > 65% 5 Clinical findings associated with polycythemia might include: Plethora, tachycardia, color changes Ruddy, tachypnea, increased work of breathing Delayed capillary refill, increased oxygen requirement, cyanosis All of the above 6 The blood volume of a newborn is approximately? 40-60 mL/kg 60-80 mL/kg 80-100 mL/kg 100-110 mL/kg 7 Conditions potentially placing an infant "at risk" for developing hyperbilirubinemia might include: a:  Polycythemia & prematurity b:  ABO Incompatibility c:  Brusing & dehydration d:  Ventilated with IV fluids a & b a & c a, b, c All of the above 8 Which of the following nursing issues/care would be implemented for the infant undergoing photherapy? Temp checks Q 1hours 'til stable, eye patches w/light Maximum exposure, fluids, I & O Light & eye patches off with all labs 1 & 3 All of the above 9 Conditions potentially placing an infant "at risk" for developiing sepsis might include: Prematurity & Prolonged rupture of the membranes Central lines & Invasive procedures Staff/visitors & Immature immune system 1 & 2 All of the above 10 Two (2) clinical manifestations of sepsis in the respiratory system might include: Increased work of breathing & respiratory support Tachypnea & increased oxygen needs Apnea & color changes 1 & 3 All of the above 11 Two (2) clinical manifestations of sepsis in the GI system might include: Decreased bowel sounds & presence of bowel loops Distention with residuals & emesis Decreased abdominal girth with emesis 1 & 2 All of the above 12 Two (2) clinical manifestations of sepsis in the renal/metabolic system might include: Hypoglycemia & acidosis Hypercalcemia & hypoglycemia Diminished output & increased specific gravity 1 & 3 All of the above 13 Medication order reads:  Gentamicin 2 mgm IV Q 18 hours.  Draw trough with 2nd dose.  Initial dose was saministered on 4/1/04 @ 1930 hours.  When is the 2nd dose due? 4/2/04 @ 0730 hrs 4/2/04 @ 1330 hrs 4/2/04 @ 1930 hrs 4/3/04 @ 0130 hrs 14 An acceptable gentamicin trough level and when should it be drawn? < 5, draw half hour before dose < 5, draw one hour before dose < 2, draw half hour before dose < 2, draw one hour before dose 15 When caring for an infant on Amphotericin B and/or Indocin, what nursing issues/care should be implemented? Maintain fluid and electrlyte balance Give diuretics per order Monitor urine output and specific gravity All of the above 16 Amphotericin B is administered over what time frame? Q 1 hour Q 2 hours Q 4 hours Q 8 hours 17 Why is a bath given prior to the administration of the Hepatitis B Vaccine? To minimize exposure to staff To minimize innoculating infant with Hepatitis B virus It makes the mother feel better about the baby getting the vaccine It is not necessary and, in fact, will chill the baby 18 An infant who has "latched on,"  is suckling well and in no distress is allowed to nurse: For 5 minutes on each breast For a total of 15 minutes Until he/she comes off the breast him/herself None of the above 19 Physiologic monitoring should ccure for infants receiving methylxanthines.  This is because one of the most common side effects to methylxanthines is: Tachypnea Tachycardia Hyperoxygenation Hyperreflexia 20 Dopamine may improve acid-base status by: Increasing cardiact contractility Decreasing cardiac output Increasing renal blood flow Increasing sodium excretion 21 Ordered:  Ampicillin 245 mg IV Q 12 hours On Hand:  Ampicillin 500 mg/5mL Houw much medication will you draw up and administer? 0.245 mLs 2.45 mLs 24.5 mLs None of the above 22 Which shaded area is correct for performing a heelstick precedure?                   A B C D 23 How frequently are saline locks generally flushed? Q 1 hour Q 2 hours Q 4 hours Only as ordered 24 Drug of choice used to paralyze infants is: Fentanyl Pavulon Valium None of the above 25 Fentanyl is administered over what time frame? 15 minutes 30 minutes 1 hour 2 hours 26 Your baby has a respiratory acidosis.  You would expect the values to demonstrate: Increased pH, Increased CO2 Decreased pH, Decreased CO2 Increased pH, Decreased CO2 Decreased pH, Increased CO2 27 Your baby has a metabolic acidosis.  You would expect the values to demonstrate: Decreased pH, Decreased bicarb Increased pH, Decreased bicarb Increased pH, Increased bicarb Decreased pH, Increased bicarb 28 Who am I? pH:  7.25 PaCO2:  55 PaO2:  72 Bicarb:  18 BE/BD:  -1 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis 29 Who am I? pH:  7.28 PaCO2:  55 PaO2:  60 Bicarb:  22 BE/BD:  -2 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis 30 The anatomical location of the ductus arteriosus is between? The right and left atria The right and left ventircles The right and left pulmonary arteries The pulmonary artery and the aorta 31 Which of the following are indicative of a Patent Ductus Arteriosus? Active precordium & increasing respiratory support Tachypnea and tachycardia Bounding peripheral puses 1 & 3 All of the above 32 The drug of choice to maintain patency of the PDA is: Indocin Prostaglandin E1 33 The drug of choice to close the PDA is: Indocin Prostaglandin E1 34 Initiating the transistion to an adult configuration of blood flow is set in motion by: Suctioning the infant's mouth and nose on the mother's perineum clamping the umbilical cord The infant establishing efffective respirations None of the above 35 What nursing assessment must always precede the administration of any methylxanthine (eg. caffeine) Temperature Respiratory rate Heart rate BP 36 When completing the assessment above, what is an acceptable value? 98.6 < 60 bpm < 180 bpm 35-50/25-35 37 Ordered:  Caffeine 3 mg IV Q 12 hours On Hand:  Caffeine 20 mg/mL  10 mL vial How much medication will you draw up and administer? 0.15 mLs 0.3 mLs 1.5 mLs 3.0 mLs 38 What nursing assessment must always precede the administration of digoxin? Temperature Respiratory rate Heart rate BP 39 When completing the assessment above, what value is acceptable? 98.6 > 40 bpm > 100 bpm 35-50/25-35 40 When performing an Allen's Test what 2 vessles are you evaluating for adequate circulation? Radial and brachial veins Ulnar and radial veins Radial and brachial arteries Ulnar and radial arteries 41 During the Allen's Test, 2 vessels are occluded to cause blanching.  Which vessel is released to demonstrate adequate circulation? Radial vein Brachial artery Ulnar artery Ulnar vein 42 If adequate circulation is not demonstrated by this maneuver, what action do you take? Do not stick and ask another nurse to try the test Do not stick and notify the charge nurse Do not stick and notify the NNP Do not stick 43 Drug of choice used to treat seizures in the neonate is: Pavulon Phenobarbital Valium Ativan 44 If IV extravasation occurs, I can cause burns and tissue necrosis.  If given by rapid IV administration I may cause bradycardia.  If given IM I crystallize in the muscle.  If given PO my absorption is erractic.  Who am I? Phenobarbital Valium Dilantin Fentanyl 45 Ordered:  Clindamycin 5 mg IV On Hand:  150 mg/mL How much medication will you draw up and administer? 0.015 mL 0.03 mL 0.15 mL 0.3 mL 46 Always attempt to start an IV at the distal end of the vein. True False 47 Scalp IVs should be aimed toward the crown of the head. True False 48 The primary source of calories in TPN is Amino Acids. True False 49 Lipids are useful in providing caloires for fluid restricted infants. True False 50 There is an increased risk of "catheter" emboli occurring with repeated reinsertion of the needle during IV attempts. True False 51 AccuCheck (bedside glucose) values that would concern you and indicate you need to inform the medical team are: < 40 and > 110 < 40 and > 180 < 30 and > 110 < 30 and > 180

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