Orientation Test: NICU Internship There are 65 questions on this test.  A score of 80% is required to be successful;  no more than 13 questions may be incorrect.  Good Luck!! First name:   Last name:   Title   Hospital Name   Street   City, State, Zip Code   Phone Number     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 pharmacologic agent used in our unit to treat apnea of prematurity is: Theophylline Caffeine Citrate Albuterol Aminophylline 3 Surfactant maturation is usually completed at what gestational age? 26-28 weeks' gestation 30-32 weeks' gestation 34-36 weeks' gestation 38-40 weeks' gestation 4 The endotracheal medication given to prevent or minimize RDS is: Caffeine Citrate Theophylline Dexamethasone Survanta 5 Oxygen dependency after 28 days of age might indicate what pulmonary disease? Respiratory Distress Syndrome Neonatal apnea Pulmonary hypertension Brochopulmonary Dysplasia 6 Extremely Low Birthweight (ELBW) guidelines are implemented for infants weighing ???? grams to  ????   < 1500 grams,  minimize skin breakdown < 1200 grams,  minimize stimulation < 1000 grams,  minimze skin breakdown  < 800 grams,  mimimize stimulation 7 To minimize environmental stimulation the bedside nurse might: a:  Dim the lights at the bedside b:  Cover the top of the isolette c:  Take report away from bedside d:  Remove equipment from top of isolettes a & b b & c c & d All of the above 8 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% 9 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 10 The blood volume of a newborn is approximately? 40-60 mL/kg 60-80 mL/kg 80-100 mL/kg 100-110 mL/kg 11 Conditions potentially placing an infant "at risk" for developing hyperbilirubinemia might include: a:  Polycythemia & prematurity b:  ABO Incompatibility c:  Bruised & dehydrated d:  Ventilated with IV fluids a & b a & c a, b, c All of the above 12 Which of the following nursing issues/care would be implemented for the infant undergoing phototherapy? Temp checks Q1 hr 'til stable, Eye patches w/light Maximum exposure, Fluids & I&O Lights & eye patches off with all labs, 1 & 3 All of the above 13 The primary energy source for all cellular activity is: Amino Acids Protein Glucose Lipids 14 Infants of diabetic mothers are "at risk" for hypoglycemia because maternal glucose crosses the placenta while insulin does not. True False 15 For the fetus, the organ of oxygenation & nutrient delivery and CO2 & waste removal is the: Placenta Fetal & Maternal livers Pulmonary system GI & Renal system 16 Conditions potentially placing an infant "at risk" for developing sepsis might include: Prematurity & Prolonged rupture of the membranes Central lines & invasive procedures Staff/visitors & Immature immune system 1 & 2 All of the above 17 Per our policy, guidelines for beginning of shift handwashing are: 45 second handwash from fingertips to elbows 30 second handwash from fingertips to elbows 15 second handwash from fingertips to elbows 1 minute handwash from fingertips to elbows 18 The above guidelines also includes a palm-sized "puff" of foam rubbed until dissolved. True False 19 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 20 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 21 Two (2) clinical manifestations of sepsis in the renal/metabolic systems might include: Hypoglycemia & acidosis Hypercalcemia & hypoglycemia Diminished output & increased specific gravity 1 & 3 All of the above 22 Medication order reads:  Gentamicin 2 mgm IV Q 18 hours.  Draw trough with 2nd dose. Initial dose was administered on 4/1/04 @ 1930 hrs.  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 23 A acceptable gentamicin trough level is & 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 24 When caring for an infant on Amphotericin and/or Indocin, what nursing issues/care should be implemented? Maintain fluid and electrolyte balance Give diuretics per order Monitor urine output and specific gravity All of the above 25 Ampicillin is administered over what time frame? 3-5  minutes 5-10 minutes 30 minutes None of the above 26 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 27 Amphotericin B is administered over what time frame? 1 hour 2 hours 4 hours 8 hours 28 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 29 Two (2) days following the birth of her premature infant, a mother is upset because she isn't getting any milk when she uses the breast pump.  Your response would be: You must not be pumping correctly, let me show you how to use the pump Encourage her to pump longer each time Tell her to skip a few pumpings so her milk supply will build up Tell her breastmilk usually doesn't come in until days 2-5, continue to pump Q 3-4 hours 30 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 31 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 32 Who am I? pH:  7.25 PaCO2:  55 PaO2:  72 Bicarb:  18 BE/BD:  -1 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic alkalosis 33 Who am I? pH:  7.28 PaCO2:  55 PaO2:  60 Bicarb:  22 BE/BD:  -2 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis 34 Who am I? pH:  7.22 PaCO2:  36 PaO2:  68 Bicarb:  14 BE/BD:  -10 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis 35 In fetal days, pulmonary vascular resitance is: Elevated/increased Lowered/decreased 36 At the same time in fetal days, systemic vascular resistance is: Elevated/increased Lowered/decreased 37 In fetal days blood is diverted away from the pulmonary system and pulmonary arterial bed to the: Pulmonary artery into the aorta Foramen Ovale into the right atrium Ductus Venosus into the aorta Ductus Arteriosus into the aorta 38 This diversion is said to be a: Right to left shunt Left to right shunt 39 The anatomical location of the ductus arteriosus is between? The right and left atria The right and left ventricles The right and left pulmonary arteries The pulmonary artery and the aorta 40 Which of the following are indicative of a Patent Ductus Arteriosus? Active precordium & increasing respiratory support Tachypnea and tachycardia Bounding peripheral pulses 1 & 3 All of the above 41 The drug of choice to maintain patency of the PDA is: Indocin Prostaglandin E1 42 The drug of choice to close the PDA is: Indocin Prostaglandin E1 43 Initiating the transition to an adult configuration of blood flow is set in motion by: Suctioning the infant's mouth & nose on the mother's perineum Clamping of the umbilical cord The infant establishing effective respirations None of the above 44 Each infant receives a copy of The Baby Book on admission.  When do you initiate parental teaching using the book? As soon after admission when mom visits When the infant is moved to an open crib A few days before discharge The nurse doesn't use it, it is for the mother's use 45 How frequently are saline locks generally flushed? Q 1 hour Q 2 hours Q 4 hours Only as ordered 46 What nursing assessment must always precede the administration of any methylxanthine (eg. caffeine)? Temperature Respiratory rate Heart rate BP 47 When completing the assessment above, what is an acceptable value? 98.6 <60 bpm < 180 bpm 35-50/25-35 48 Which of the following statements is/are true of a Dopamine drip? a:  Vital signs Q 1 hour b:  No stopcocks or interruptions c:  Site inspection for blanching d:  Maintain on infusion pump a, b, c a, b, d a, c, d All of the above 49 A Dopamine drip may routinely be adminsitered via the UAC. True False 50 The IV solution used prior to and following the adminstration of blood is: D5W Normal Saline Ringers Lactate None of the above 51 What nursing assessment must always precede the administration of digoxin? Temperature Respiratory rate Heart rate BP 52 When completing the assessment above, what value is acceptable? 98.6 > 40 bpm > 100 bpm 35-50/25-35 53 When performing an Allen's Test what 2 vessels are you evaluating for adequate circulation? Radial & brachial veins Ulnar & radial veins Radial & brachial arteries Ulnar & radial arteries 54 During the Allen's Test, 2 vessels are occluded to cause blanching.  Which vessel is released to demonstrate adequate circulation? Ulnar artery Radial artery Ulnar vein Brachial vein 55 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 56 Ordered:  Ampicillin 245 mg IV Q 12 hours On Hand:  Ampicillin 500 mg/5 mL How much medication will you draw up and administer? 0.245 mLs 2.45 mLs 24.5 mLs None of the above 57 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 3.0 mLs None of the above 58 Which shaded area is correct for performing a heelstick procedure?                          A B C D 59 Always attempt to start an IV at the distal end of the vein. True False 60 In the event of a clot, the nurse should immediately irrigate the IV. True False 61 Scalp IVs should be aimed toward the crown of the head. True False 62 The primary source of calories in TPN (yellow fluid) is Amino Acids. True False 63 Lipids are useful in providing calories for fluid restricted infants. True False 64 There is an increased risk of "catheter" emboli occurring with repeated reinsertion of the needle during IV attempts. True False 65 What AccuChek value would concern you and indicate notification of the medical team is needed.  <30 or > 100 < 30 or > 150 < 40 or > 180 < 60 or > 200 66 What class/classes did you find of most benefit? 67 What class/classes did you find of least benefit? 68 What class/classes would you have liked to be longer, more in-depth? 69 What class/classes would you have liked to be shorter, less in-depth?

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