Resuscitation Care

1. The need for resuscitation of the newborn at risk can be anticipated if what risk factors are present? Select
all that apply.
a. Difficult birth
b. Female infant
c. Multiple births
d. Known congenital diaphragmatic hernia
e. Sepsis with cardiovascular collapse

2. The highest priority intervention the nurse must perform before resuscitating a newborn with
asphyxia is:
a. Suctioning.
b. Drawing a blood gas.
c. Intubation.
d. Initiating positive pressure ventilation.

3. What is the correct way to perform external cardiac massage on an infant without a detectable
heart rate?
a. Place 2 fingers a finger width below the nipple line and compress 1/2-1 inch.
b. Place a thumb a finger width below the nipple line and compress at a 5:1 ratio.
c. Place both thumbs over the lower third of the sternum with fingers wrapped
around and supporting the back.
d. Use the heel of one hand at the nipple line and compress at a ratio of 5:1.

4. The nurse should anticipate that the physiologic alterations of respiratory distress syndrome
(RDS) can produce which of the following? Select all that apply.
a. Hypoxia
b. Respiratory acidosis
c. Hemoglobinopathies
d. Metabolic alkalosis

5. The highest-priority nursing diagnosis for a neonate experiencing RDS is:

a. Altered Nutrition: More Than Body Requirements
b. Alterations in Parenting
c. Acute Pain
d. Impaired Gas Exchange, related to inadequate lung surfactant

6. A nurse is assessing a 37-week gestation newborn born by cesarean section, and now at 4 hours of
age on room air. The newborn had no breathing problems at birth. The nurse notes the following
signs: expiratory grunting, flaring of the nares, mild cyanosis, and respirations of 120 bpm. The
newborn is most likely experiencing:
a. RDS (respiratory distress syndrome).
b. Transient tachypnea of the newborn.
c. Apnea of prematurity.
d. Congenital diaphragmatic hernia.

7. To obtain a blood specimen from the heel of a neonate, what intervention could a nurse perform
to create adequate vasodilation? Select all that apply.
a. Wrap the foot in a warm washcloth.
b. Apply pressure to the heel with moderate force.
c. Apply warm diaper.
d. Perform venipuncture; heel sticks are rarely performed on the neonate.

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8. The nurse correctly describes physiologic jaundice to the parents of a newborn in the following
manner:
a. Jaundice usually stays visible for 20-25 days.
b. Jaundice is considered an abnormal process that occurs during transition from intrauterine to
extrauterine life and appears before 24 hours of life.
c. It is considered a normal process that occurs during transition from intrauterine to
extrauterine life and appears after 24 hours of life.
d. There is no statistical difference between breastfed & bottle-fed babies regarding bilirubin
levels.

9. A physician or practitioner would order a Coombs' test in order to determine:

a. Blood type of the infant.
b. Whether jaundice is due to Rh or ABO incompatibility.
c. A positive left shift indicating possible infection.
d. Hemoglobin and hematocrit levels.

10. In planning care for a newborn with polycythemis, the nurse would know that common
symptoms of polycythemia include:
a. Apnea, hypotension, hyperthermia.
b. Orthopnea, tachypnea, hyperbilirubinemia.
c. Tachycardia, respiratory distress, hyperbilirubinemia.
d. Bradycardia, hypotension, and leukopenia.

11. You are attempting resuscitation of an infant or child with severe symptomatic bradycardia and
no evidence of vagal etiology. The bradycardia persists despite establishment of an effective airway,
oxygenation, and ventilation. Which of the following is the first drug you should administer?

a. atropine
b. dopamine
c. adenosine
d. epinephrine

12. A 7-year-old boy is found unresponsive, apneic, and pulseless. CPR is provided, and tracheal
intubation and vascular access are achieved. The ECG monitor reveals pulseless electrical activity
(PEA). An initial IV dose of epinephrine has been administered, and effective ventilations and
compressions continue for 1 minute. Which of the following therapies should you perform next?

a. attempt to identify and treat reversible causes (using the 4 H's and 4 T's as a memory aid)
b. attempt defibrillation at 4 J/kg
c. administer escalating doses of epinephrine
d. administer synchronized cardioversion

13. Which of the following statements about the effects of epinephrine during attempted
resuscitation is true?

a. epinephrine decreases peripheral vascular resistance and reduces myocardial afterload so that
ventricular contractions are more effective
b. epinephrine can improve coronary artery perfusion pressure and can stimulate spontaneous
contractions when asystole is present
c. epinephrine is not useful in ventricular fibrillation because it will increase myocardial irritability
d. epinephrine decreases myocardial oxygen consumption

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14. You are participating in the elective intubation of a 4-year-old child with respiratory failure.
You must select the appropriate size of uncuffed tracheal tube. Which of the following sizes is most
appropriate for an average 4-year-old?

a. 3-mm tube
b. 4-mm tube
c. 5-mm tube
d. 6-mm tube

15. You are in a restaurant when a woman at the next table cries out, "I think he's choking." You
look over and see a 3-year-old child who does appear to be choking. You go to the table and confirm
that the child is responsive, but he is cyanotic, unable to cough or talk, and is not moving air. Which
of the following is the most appropriate initial therapy for this child?

a. give 5 back blows and then 5 chest thrusts

b. perform a blind finger sweep
c. do not intervene unless the child becomes unresponsive; then perform abdominal thrusts
d. tell the victim you will help and give abdominal thrusts

16. A 2-year-old child presents with mild difficulty breathing of gradual onset. She is alert, but she
has a sore throat and is making coarse, high-pitched inspiratory sounds (mild stridor). Her
oxyhemoglobin saturation is 94% in room air, and her lung sounds are clear with adequate breath
sounds bilaterally. Which of the following is the most appropriate initial intervention for this child?

a. immediate tracheal intubation

b. immediate radiologic evaluation of the soft tissues of the neck
c. evaluation of oxyhemoglobin saturation with pulse oximetry and analysis of arterial blood
gases to determine if hypercarbia is present
d. administration of humidified supplemental oxygen as tolerated and continued evaluation

17. A term infant is placed under a radiant warmer, the skin is dried, and the oropharynx and nose
are suctioned. After tactile stimulation, there is minimal respiratory effort, dusky color, and a heart
rate of 86 beats/min. Bag/mask ventilation is performed for 30 seconds with 100% oxygen at a rate
of 40 to 60 breaths/min. The heart rate increases to 100 beats/min. Of the following, the NEXT best
step is to:

a.administer sodium bicarbonate

b.continue bag/mask ventilation at a rate of 20 to 40 breaths/min
c.continue ventilation and begin chest compressions
d.observes for spontaneous respiration and discontinues ventilation

The most common form of shock in the pediatric patient is

a. hypovolemic
b. septic
c. neurogenic
d. cardiogenic

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Your 3 year old patient is in shock and continues to display persistent bradycardia and cyanosis
despite aggressive oxygenation efforts. You should next treat this with oxygenation in the pediatric
patient may be treated with

a. dopamine
b. CPR
c. Epinephrine
d. glucose

The premature infant who has been apneic for 25 seconds turns pale and limp and is unresponsive
to your touch. What is the next step in treatment?
Bag mask ventilation is a fast and easily accessible way to provide air exchange at this time.

In resuscitating a collapsed neonate:

A 10ml/kg of fluid should be given if hypovolemia is suspected. (True)
B Treatment of metabolic acidosis would be with 10mmol/kg of sodium bicarbonate. (False)
C Naloxone may be used to stimulate respiration in a child born by caesarean section under general
anesthesia. (False)
D In asystole, the first dose of adrenaline should be 10mcg/kg. (True)
E Atropine is frequently useful for bradycardia. (False)