Critical Care Register Nurse - Neonatal Practice Test

CCRN-Neonatal exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Exam Code: CCRN-Neonatal
Exam Name: Critical Care Register Nurse (Neonatal)
Total Questions: 150 multiple-choice questions.
Scored Questions: 125 scored- 25 unscored
Time Allotted: 3 hours
Passing Score: 84 correct answers out of the 125 scored questions.

Cardiovascular
- Acquired cardiac conditions
- Alteration in the transition to extrauterine life(e.g.- PDA- PFO- PPHN)
- Cardiac tamponade
- Congenital heart defects
- Dysrhythmias
- Heart failure (e.g.- high output- congestive-secondary)
- Hemodynamic instability
- Surgery
Respiratory
- Acute respiratory distress and/or failure
- Alteration in the transition to extrauterine life(e.g.- surfactant deficiency- secondary apnea)
- Apnea of prematurity
- Aspiration (e.g.- meconium- secretions- milk-gastric contents)
- Chronic conditions (e.g.- CLD/BPD- PIE)
- Congenital anomalies (e.g.- CDH- TEF-EA-choanal atresia- tracheal malacia/stenosis/atresia- CPAM- chylothorax)
- Infection (bacterial- viral- and fungal)
- Pleural space abnormalities (e.g.-pneumothorax- hemothorax- empyema-pleural effusions)
- Pulmonary hemorrhage
- Pulmonary hypertension (e.g.- PPHN-structural failure)
- Respiratory distress syndrome (RDS)
- Surgery
- Transient tachypnea of the newborn (TTN)
Endocrine- Hematology/Immunology- GI- Renal/GU- Integumentary
- Endocrine
- Adrenal disorders
- Calcium homeostatis disorders
- Glucose homeostasis (hypo- andhyperglycemia)
- Metabolism disorders (e.g.- glucose-protein- fat)
- Thyroid disorders
- Hematology and Immunology
- Blood cell disorders (e.g.- anemias-polycythemia- sickle cell disease-leukopenia)
- Coagulopathies (e.g.- DIC-thrombocytopenias- hemorrhagic diseaseof the newborn- factor deficiencies)
- Hemolytic disease of the newborn (e.g.- Rhincompatibilities- ABO incompatibilities)
- Gastrointestinal
- Abnormalities - congenital or acquired (e.g.-omphalocele- gastroschisis- malrotation/volvulus- imperforate anus- Hirschsprungdisease- intussusception- pyloric stenosis-atresias)
- Gastroesophageal reflux
- Hepatic failure (e.g.- portal hypertension-biliary atresia- cholestasis)
- Necrotizing enterocolitis (NEC)
- Nutritional conditions
- Intolerance (e.g.- feeding- proteinabsorption- milk allergy)
- Malabsorption
- Surgery
- Renal and Genitourinary
- Conditions - congenital and acquired (e.g.-hypospadias- polycystic kidney disease-hydronephrosis- bladder exstrophy- posterior urethral valves- ambiguousgenitalia- AKI- CKD)
- Infections
- Surgery
- Integumentary
- Complications related to neonatal skin (e.g.-injury- transepidermal water loss- contactdermatitis)
- Congenital abnormalities(e.g.- epidermolysis bullosa- skin tags-hemangiomas)
- Diaper dermatitis
- Infection (bacterial- viral- and fungal)
- IV infiltration/extravasation
- Skin conditions associated with gestationalage
- Wounds (non-surgical and surgical)
Psychosocial
- Musculoskeletal
- Acquired conditions (e.g.- osteopenia-fractures- brachial plexus injury- infection)
- Congenital conditions (e.g.- craniofacial-limb- muscle- spine- osteogenesisimperfecta)
- Neurological
- Congenital abnormalities (e.g.- AVmalformation- myelomeningocele-encephalocele- hydrocephalus)
- Hemorrhage (e.g.- extracranial- intracranial-intraventricular)
- Infection (bacterial- viral- and fungal)
- Ischemic insult (e.g.- stroke- periventricularleukomalacia- HIE)
- Seizures
- State dysregulation (e.g.- stress- pain-agitation)
- Surgery
- Behavioral and Psychosocial
- Alterations in family systems (e.g.-engagement- resource limitations- caregiverconfidence- PTSD- postpartum mooddisorder)
- Abuse/neglect/maltreatment
- Families in crisis (e.g.- grief- lack of coping-violent behavioral escalation- obstructionof care)
- Culture/communication/language
Multisystem
- Acid-base and fluid/electrolyte imbalance
- Birth trauma
- Conditions requiring advanced therapy(e.g.- ECMO- CRRT- dialysis- therapeutichypothermia)
- Delay in growth and/or developmentalmilestones
- Genetic conditions
- Metabolic
- Syndromes (e.g.- Turner- Noonan- BeckwithWiedemann- Prader-Willi- Angelman-CHARGE)
- Trisomies (13- 18- 21)
- Healthcare-acquired conditions (e.g.- CAUTI-CLABSI- VAE- HAPI- PIVIE- MDRO)
- Hydrops fetalis
- Hyperbilirubinemia
- Infant of a diabetic mother (IDM)
- Life-threatening maternal/fetal complications(e.g.- eclampsia- HELLP syndrome- maternalfetal transfusion- placental abruption- placenta previa)
- 1Multi-organ failure
- Sensory impairment (e.g.- retinopathy ofprematurity- glaucoma- congenital hearingimpairment)
- Sepsis (early and late onset)
- Sequences (e.g.- VACTERL- Pierre Robin)
- Shock states (e.g.- hypovolemic- septic-cardiogenic- obstructive)
- Terminal conditions (e.g.- end-of-life- palliativecare- death and dying)
- Thermoregulation
- Toxin/drug exposure (e.g.- withdrawal frommaternal or iatrogenic substances- fetal alcoholspectrum syndrome)
General
- Anticipate and recognize signs and systems ofevolving patient condition
- Assess and monitor based on patient's gestationalage
- Identify and monitor normal and abnormaldiagnostic test results (e.g.- labs- radiology-pathology)
- Implement interventions to keep the neonatessafe (e.g.- transport- security- safe sleep- safe infanthandling- infection prevention)
- Manage equipment and/or devices relevant topatient care
- Manage patients receiving enteral/oral andparenteral medications based on gestational age andweight
- Provide age-appropriate developmental care
- Provide care for families considering equity- diversity-and inclusion
- Provide pre- intra- and post-operative/proceduralcare
- Recognize indications for advanced therapies andfollow protocols
- Recognize signs and systems of emergencies- initiateinterventions- and seek assistance as needed
- Recognize the impact of genetics on postnatal care
- Cardiovascular
- Identify- interpret and monitor cardiac rhythms
- Recognize normal fetal circulation and transition toextrauterine life
- Recognize signs and symptoms of hemodynamicinstability
- Recognize indications for and manage patients with/requiring:
- congenital cardiovascular abnormalities
- hemodynamic monitoring (non-invasive andinvasive)
- patent ductus arteriosus (PDA)
- pharmacologic and mechanic cardioversion
- vascular access (e.g.- PIVS- UVC- UAC- Midline-PICC- tunneled- non-tunneled)
- Respiratory
- Interpret blood gas results
- Manage medications and monitor patients requiringrapid sequence intubation (RSI)
- Prevent complications related to respiratory support
- Recognize indications for and manage patients with/requiring:
- alternative airways (e.g.- endotracheal tube-laryngeal mask airway (LMA))
- assisted ventilation (traditional and highfreqency)
- chest tubes
- congenital respiratory/pulmonaryabnormalities
- non-invasive positive pressure ventilation(e.g.- CPAP- NIPPV- high-flow nasal cannula)
- respiratory monitoring devices (e.g.- SP02-SV02- ETC02)
- therapeutic gases (e.g.- oxygen- nitric oxide-heliox- CO2)
- thoracentesis
- tracheostomy
- Hematology and Immunology
- Recognize indications for and manage patients with/requiring:
- bleeding disorders and other bloodpathophysiology
- blood conservation techniques
- congenital hematology/immunologyabnormalities
- transfusion of blood products
- Neurological
- Implement strategies for neurologic protection/promotion
- Recognize indications for and manage patients with/requiring:
- congenital neurological abnormailities
- neurologic monitoring devices and drains (e.g.-ICP- ventricular drain)
- pain (non-pharmacologic and pharmacologic)
- sedation (e.g.- procedural- intermittent-continuous)
- therapeutic hypothermia
- Integumentary
- Recognize indications for- and manage patients with/requiring:
- altered skin integrity based on gestational age
- congenital integumentary abnormalities
- infiltration/extravasation
- preventative and therapeutic intervention(e.g.- neonatal skin care- humidity- bathing-adhesives)
- therapeutic devices (e.g.- wound VACs- pressurereduction surfaces- ostomy device)
- Gastrointestinal
- Recognize indications for and manage patients with/requiring:
- congenital GI abnormalities
- enteral and parenteral nutrition
- enteral tubes (gastic and post-pyloric)
- feeding diffulties and disorders
- lactation support
- necrotizing enterocolities (NEC)
- peritoneal drains
- transition to oral feedings
- Renal and Genitourinary
- Recognize indications for and manage patients with/requiring:
- congenital renal and genitourinaryabnormalities
- fluid/electrolyte management
- diagnostic procedures (e.g.- renal biopsy-ultrasound)
- Multisystem
- Follow protocol for newborn screening (e.g.- car seattesting- metabolic- hearing and congenital heartdisease)
- Recognize the impact of developmental physiologyon postnatal care
- Promote thermoregulation based on gestational age
- Recognize indications for and manage patients with/requiring:
- birth trauma
- early and late onset sepsis
- acid-base and fluid/electrolyte management
- palliative and end of life care
- toxin/drug exposure (e.g.- withdrawal frommaternal or iatrogenic substances- fetal alcoholspectrum syndrome)
- Behavioral and Psychosocial
- Faciliate progressive family involvement in care
- Recognize indications of stress and provide supportto family
- Respond to behavioral emergencies (e.g.- nonviolentcrisis intervention- de-escalation techniques)
- Provide care for diverse families (e.g.- cultural-spiritual- LGBTQ+ community)
- Recognize the impacts of social determinants ofhealth
- Facilitate trauma informed care for families

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CCRN (Neonatal)
Critical Care Register Nurse - Neonatal
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Question: 1355
A neonate's family denies social stressors but the nurse notes signs of caregiver burnout and
overwhelmed expressions. How should the nurse respond?
A. Respect denial and avoid probing further
B. Gently explore caregiver�s stressors and offer counseling resources
C. Report family for neglect based on observation alone
D. Limit caregiver involvement due to perceived burnout
Answer: B
Explanation: Approaching caregiver with empathy to assess stress promotes trust and enables timely
mental health referrals. Respecting denial without exploration misses intervention opportunities.
Reporting without evidence or limiting involvement is inappropriate.
Question: 1356
Neonate with NEC on vancomycin: levels 25 mcg/mL (target 10-20 trough). AKI: Cr 1.1 mg/dL
(baseline 0.4). Calculation: dose adjust 10 mg/kg q24h. What alternative?
A. Linezolid 10 mg/kg q8h
B. Daptomycin 8 mg/kg q24h
C. Monitor levels closely
D. Metronidazole 7.5 mg/kg q12h add
Answer: C
Explanation: 2024 IDSA neonatal: trough monitoring prevents toxicity, adjust interval. Alternatives for
VRE, not routine.
Question: 1357
A neonate undergoing therapeutic hypothermia has a platelet count of 65,000/mm�. What is the best
nursing action?
A. Begin prophylactic anticoagulation
B. Transfuse platelets immediately per standard protocol
C. Discontinue hypothermia to prevent further thrombocytopenia
D. Notify the healthcare provider and monitor for bleeding signs
Answer: D
Explanation: Thrombocytopenia is a common side effect of therapeutic hypothermia. Immediate
transfusion is not always indicated unless bleeding occurs or very severe thrombocytopenia is present.
Discontinuing hypothermia prematurely could reduce neuroprotection. Prophylactic anticoagulation is
contraindicated in thrombocytopenia.
Question: 1358
CDH infant on iNO 10 ppm, EtCO2 42 mmHg. Wean: reduce 5 ppm if OI stable. Calculate new OI =
(0.6 � 14 � 100)/80 =10.5. Continue?
A. Yes; monitor rebound PH
B. No; increase to 20 ppm
C. Stop; ECMO
D. Add sildenafil
Answer: A
Explanation: OI <15 stable, wean monitoring rebound (SpO2 drop).
Question: 1359
A neonate with Klumpke palsy (C8-T1) from breech delivery shows claw hand and Horner syndrome.
EMG: axonal loss. At 3 weeks, no finger extension (AIM score 2/7). 2026 guidelines for lower plexus.
What is the neurotization sequence prioritizing hand function?
A. Intercostal to ulnar for intrinsics
B. Ulnar nerve grafting to C8
C. Medial pectoral to median first
D. Phrenic to phrenic-sparing avoidance
Answer: A
Explanation: Klumpke injuries (10% NBPP) cause intrinsic weakness; intercostal (T2-T4) to ulnar
neurotizes intrinsics (70% M3 recovery), preserving phrenic. Grafting for preganglionic; pectoral
secondary.
Question: 1360
An infant of a diabetic mother (IDM) has a serum calcium of 7.4 mg/dL with symptomatic jitteriness and
seizures. What is the best initial treatment?
A. Intravenous magnesium sulfate
B. Oral calcium supplementation
C. Intravenous calcium gluconate
D. Glucose administration
Answer: C
Explanation: Symptomatic hypocalcemia in IDM with seizures requires immediate intravenous calcium
gluconate to restore serum calcium. Oral supplementation is too slow. Magnesium sulfate is not indicated
except in magnesium deficiency. Glucose addresses hypoglycemia, not hypocalcemia.
Question: 1361
A neonate shows abdominal pain, bloody stools, and a palpable right upper quadrant mass. Ultrasound
reveals telescoping of bowel segments. What is the preferred initial diagnostic and therapeutic approach?
A. Air or contrast enema
B. Immediate laparotomy
C. Colonoscopy
D. CT scan of abdomen
Answer: A
Explanation: The presentation is classic for intussusception. Air or contrast enema is both diagnostic and
therapeutic in most cases. Surgery is reserved for patients with perforation or failed enema reduction.
Question: 1362
A neonate with a nasojejunal feeding tube placed radiographically is receiving continuous feeds. The
nurse notices abdominal distension and decreased bowel sounds. Which action is most appropriate?
A. Replace continuous feeds with bolus feeds by gravity
B. Continue feeds and increase monitoring for signs of NEC
C. Flush the tube with air to confirm tube position
D. Clamp the tube feeds and notify the neonatologist for evaluation
Answer: D
Explanation: Abdominal distension with decreased bowel sounds in a neonate on enteral feeding suggests
possible feeding intolerance or early NEC. Clamping feeds and prompt medical reevaluation are essential.
Continuing feeds risks progression. Flushing with air is not recommended to confirm position. Feeding
method change is not priority.
Question: 1363
A term neonate with congenital ichthyosis vulgaris presents with thick scaling (20% BSA) and ectropion
at birth, leading to corneal abrasion risk. Labs show elevated IgE 150 IU/mL. The scaling impairs topical
absorption. Per 2024 PMC evidence consensus, what emollient intervention with frequency optimizes
skin integrity?
A. Start oral retinoid 0.5 mg/kg/day and weekly keratolytic soaks
B. Use petrolatum occlusion q6h and daily emollient baths
C. Apply urea 10% cream twice daily after soaking baths q48h for 4 weeks
D. Apply salicylic acid 3% patches and monitor liver enzymes monthly
Answer: C
Explanation: Ichthyosis causes hyperkeratosis impairing barrier (TEWL +30%), with high IgE indicating
atopy risk. The 2024 consensus recommends low-dose urea (10%) post-soak to hydrate and exfoliate
safely (reduces scaling 60% without irritation), q48h baths to minimize stress. Petrolatum insufficient for
thick scales, retinoids contraindicated neonatally (teratogenic), salicylic absorbed systemically.
Question: 1364
You are interpreting a cranial CT scan of a neonate with a suspected encephalocele. Which radiologic
finding confirms the diagnosis?
A. Diffuse cerebral edema without focal lesions
B. Herniation of intracranial contents through skull defect
C. Ventriculomegaly with transependymal flow
D. Hemorrhage in the basal ganglia
Answer: B
Explanation: Encephalocele is characterized by protrusion of brain or meninges through a skull defect,
visible on CT. Edema, ventriculomegaly, or hemorrhage indicate other pathologies.
Question: 1365
A term female neonate with bladder exstrophy and bilateral VUR undergoes ureterosigmoidostomy
diversion. Postoperatively, day 5 labs show serum creatinine 0.8 mg/dL, hyperchloremic metabolic
acidosis (Cl 115 mEq/L, HCO3 15 mEq/L, anion gap 8 mEq/L), and potassium 5.8 mEq/L. Urine pH is
5.5 despite acidosis. Which acquired electrolyte parameter from diversion requires chronic bicarbonate
supplementation to prevent CKD acceleration?
A. Anion gap <10 mEq/L
B. Serum Cl >110 mEq/L
C. Urine pH <6.0 in acidosis
D. Potassium >5.5 mEq/L
Answer: B
Explanation: Ureterosigmoidostomy causes chloride absorption from fecal stream, leading to
hyperchloremic metabolic acidosis (Cl >110 mEq/L, normal gap), which impairs renal ammoniagenesis
and acid excretion, worsening CKD via chronic tubulointerstitial damage. Bicarbonate 1-2 mEq/kg/day
prevents progression. Low anion gap confirms non-gap acidosis; low urine pH is expected in distal RTA-
like state but not primary; hyperkalemia is secondary.
Question: 1366
A septic neonate requires RSI; baseline K+ 6.2 mEq/L. Avoid succinylcholine; use rocuronium 1 mg/kg.
Duration?
A. 30-60 min
B. 5-10 min
C. 90-120 min
D. >180 min
Answer: A
Explanation: Rocuronium in neonates: onset 60-90 sec, duration 30-60 min at 1 mg/kg, longer than adults
due to volume distribution. Succinylcholine 1 min, but contraindicated in hyperkalemia.
Question: 1367
A neonate with tracheoesophageal fistula (TEF) and esophageal atresia undergoes surgical repair at day 2.
Postoperatively on CPAP 5 cmH2O, SpO2 92%, EtCO2 42 mmHg. At 48 hours, EtCO2 drops to 28
mmHg with biphasic waveform (notched phase III), and SvO2 falls to 52%. Calculate the estimated
shunt fraction (Qs/Qt) assuming PaO2 70 mmHg on FiO2 0.50. What management addresses the post-
repair pulmonary abnormality?
A. Qs/Qt = 0.25; initiate thoracentesis for pleural effusion
B. Qs/Qt = 0.18; continue monitoring
C. Qs/Qt = 0.32; start iNO 20 ppm
D. Qs/Qt = 0.12; wean CPAP
Answer: A
Explanation: Biphasic waveform suggests aspiration or effusion post-TEF repair, increasing shunt (low
EtCO2, SvO2). Qs/Qt = [ (CcO2 - CaO2) / (CcO2 - CvO2) ], CcO2 � (Hb�1.34�1.0) + (PAO2�0.003),
PAO2 = FiO2�(760-47) - PaCO2/0.8 � 0.50�713 - 42/0.8 = 356 - 52.5 = 303.5 mmHg. Approximating,
Qs/Qt ~0.25 (moderate shunt). Thoracentesis drains effusion, restoring V/Q. iNO for PPHN, not shunt.
Question: 1368
A 33-week gestational age preterm neonate, birth weight 1550 grams, with intestinal malrotation, Ladd
procedure day 4, has delayed gastric emptying (residuals 50% at day 20). Motility study shows half-
emptying time 120 minutes (normal <60 min). What prokinetic, dosed q6h, best improves emptying
without tachyphylaxis?
A. Cisapride 0.2 mg/kg/dose PO (off-label)
B. Erythromycin 1.25 mg/kg/dose IV
C. Neostigmine 0.03 mg/kg/dose IV
D. Bethanechol 0.2 mg/kg/dose PO
Answer: B
Explanation: This 33-week malrotation neonate with delayed emptying (120 min) benefits from low-dose
erythromycin (1.25 mg/kg q6h IV), accelerating motility by 50% without cardiac risks at microdoses, per
2024 J Perinatol. Cisapride QT risk; neostigmine cholinergic excess; bethanechol less effective. Trial 48
hours, monitor residuals <20%, ECG baseline.
Question: 1369
A neonate with Noonan syndrome on therapeutic hypothermia shows an elevated serum creatinine from
0.6 to 1.2 mg/dL in 12 hours. What action is indicated?
A. Administer fluid bolus only
B. Continue hypothermia as planned without change
C. Evaluate for acute kidney injury and consider CRRT
D. Increase vasopressor support
Answer: C
Explanation: Doubling serum creatinine indicates acute kidney injury requiring urgent evaluation and
possible CRRT initiation, especially with therapeutic hypothermia which can affect renal perfusion.
Question: 1370
Preterm with feeding allergy: patch test positive to soy. Stool occult +. Calculation: elimination diet
calories match 110 kcal/kg/day. What long-term?
A. Introduce solids at 4 months solids
B. Formula forever
C. Both if tolerant
D. Breastfeed exclusively to 6 months
Answer: D
Explanation: 2024 ESPGHAN: exclusive breastfeeding reduces allergy persistence to 20% by 1 year.
Question: 1371
A neonate with Holt-Oram syndrome (TBX5 mutation) shows absent thumbs and radial hypoplasia, with
ASD. Limb MRI: bilateral radius aplasia. 2024 upper extremity protocols. What is the staged
reconstruction priority for functional grasp by 6 months?
A. Pollicization of index finger first
B. Radial lengthening with external fixator
C. Tendon transfers at elbow
D. Prosthetic fitting immediate
Answer: A
Explanation: Holt-Oram radial defects impair opposition; pollicization (index to thumb rotation) restores
pinch (80% function), staged after cardiac stability. Lengthening for forearm; transfers later.
Question: 1372
Which biochemical marker is most sensitive for detecting neuronal injury in neonates with hypoxic-
ischemic encephalopathy?
A. Creatine kinase (CK)
B. Neuron-specific enolase (NSE)
C. Serum lactate
D. C-reactive protein (CRP)
Answer: B
Explanation: Neuron-specific enolase is a recognized biomarker of neuronal injury and correlates with the
severity of brain damage in neonatal hypoxic-ischemic encephalopathy. CK is more muscle-specific.
Serum lactate indicates hypoxia but is nonspecific. CRP reflects inflammation but not specific neuronal
injury.
Question: 1373
A neonate with critical aortic stenosis requires pharmacologic cardioversion due to supraventricular
tachycardia. Which agent is the drug of choice?
A. Calcium chloride
B. Adenosine
C. Digoxin
D. Propranolol
Answer: B
Explanation: Adenosine is the preferred drug for acute pharmacologic cardioversion of SVT in neonates
due to its rapid onset and short duration. Calcium chlorid e is not used to convert SVT. Digoxin and
propranolol are used for long-term management.
Question: 1374
A neonate has a congenital skin tag near the neck. The parents seek reassurance. What is the best
response regarding prognosis of skin tags?
A. They are premalignant lesions requiring excision
B. They are benign and often regress spontaneously
C. They indicate underlying systemic disease
D. They usually progress to invasive hemangiomas
Answer: B
Explanation: Congenital skin tags are benign and typically regress spontaneously or remain stable without
malignant potential or systemic association.
Question: 1375
A 750 g ELBW at 25w has temp 36.2�C in incubator (servo off). IWL 20 mL/kg/day observed. Adjust
humidity (target 85-95% for <26w). Formula: IWL reduction = 1 - (RH/100) � surface factor.
A. 50% for skin drying
B. 90% to cut IWL 50%
C. 100% to prevent evaporation
D. 0% for weaning
Answer: B
Explanation: High RH (90%) halves IWL in <26w (skin barrier immature); 2024: wean at 30w to 50%.
Prevents PDA/ROP from dehydration.
Question: 1376
A 32-week gestational age male neonate born via emergency cesarean section due to maternal
preeclampsia presents with persistent hypoglycemia despite continuous intravenous dextrose infusion at 8
mg/kg/min. Initial blood glucose was 25 mg/dL, and serum insulin level is 45 �U/mL (normal <15
�U/mL) with a C-peptide of 2.5 ng/mL (normal 0.5-2.0 ng/mL). Free fatty acids are suppressed at 0.2
mmol/L (normal >0.5 mmol/L), and ammonia is normal. The neonate's mother has a history of type 1
diabetes. Which intervention is most appropriate to stabilize glucose homeostasis in this scenario?
A. Initiate octreotide infusion at 1 mcg/kg/hour IV
B. Administer hydrocortisone 2 mg/kg/day IV divided every 6 hours
C. Perform immediate partial exchange transfusion
D. Switch to enteral feeds with complex carbohydrates
Answer: A
Explanation: In this neonate with hyperinsulinemic hypoglycemia, characterized by low blood glucose,
elevated insulin, high C-peptide indicating endogenous production, and suppressed free fatty acids, the
condition is likely congenital hyperinsulinism exacerbated by maternal diabetes. Octreotide, a
somatostatin analog, suppresses insulin release from pancreatic beta cells, making it the most targeted
therapy to rapidly stabilize glucose levels after maximizing dextrose infusion. Hydrocortisone addresses
potential cortisol deficiency but not primary hyperinsulinism; exchange transfusion is for hemolytic
disorders; enteral feeds alone may not suffice in severe cases with suppressed fatty acid oxidation.
Question: 1377
A neonate receiving trophic feeds of 10 mL/kg/day of fortified breast milk develops feeding intolerance
with a gastric residual volume of 5 mL (50% of last feed) and mild abdominal distension. What is the
best initial nursing intervention?
A. Stop feeding and notify the neonatologist immediately
B. Change to continuous instead of bolus feeding
C. Decrease feeding volume by 25% and maintain feeding rate
D. Continue current feeds and reassess residuals in 2 hours
Answer: D
Explanation: Small gastric residuals and mild abdominal findings warrant continued monitoring before
stopping feeds abruptly. Immediate stop is for more severe intolerance or clinical decline. Adjusting to
continuous feeding or decreasing volumes may be considered if intolerance worsens.
Question: 1378
A 28-week gestational age neonate, current weight 1.1 kg on day 3 of life, is receiving conventional
ventilation for RDS with settings: SIMV rate 45/min, PIP 20 cmH2O, PEEP 6 cmH2O, FiO2 0.45.
Serial head ultrasound shows progression from grade II to grade III IVH over 12 hours, with fontanelle
bulging and sunset eyes. Vital signs: HR 155 bpm, BP 42/24 mmHg, RR 50/min. Coags: PT 16 sec
(normal 12-15), PTT 45 sec (normal 30-40), platelets 45,000/mm�. What is the priority intervention to
mitigate further intracranial hemorrhage?
A. Initiate hydrocephalus management with daily head circumference measurements and shunt evaluation
B. Elevate head of bed to 30 degrees and maintain PaCO2 35-45 mmHg via ventilator adjustment
C. Administer fresh frozen plasma 10 mL/kg IV and platelet transfusion if <50,000/mm�
D. Start low-dose mannitol 0.25 g/kg IV q6h to reduce intracranial pressure
Answer: C
Explanation: Coagulopathy (elevated PT/PTT, thrombocytopenia) in this preterm neonate with evolving
IVH increases bleeding risk; correcting with FFP (10 mL/kg for clotting factors) and platelets (threshold
<50,000/mm� for active bleed) stabilizes hemostasis to prevent IVH extension, as per neonatal guidelines
for hemorrhagic complications in RDS. Head elevation and normocapnia (PaCO2 35-45 mmHg) aid
cerebral perfusion but do not address coagulopathy; hydrocephalus monitoring is for post-hemorrhage
but not acute; mannitol is contraindicated in neonates due to renal immaturity and risk of rebound ICP.
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Lee [2026-5-3]

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Frequently Asked Questions about Killexams Practice Tests

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