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CNeoN(C) practice questions

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Question 1Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which finding on a routine 28-week prenatal visit most strongly suggests gestational diabetes requiring diagnostic testing?

  1. Maternal weight gain of 0.4 kg in one week
  2. Fundal height measuring 3 cm greater than expected for dates Correct answer.
  3. Blood pressure of 118/74 mmHg
  4. Fetal heart rate baseline of 150 beats per minute

Explanation

Excessive fundal height growth, polyhydramnios, or a large-for-dates fetus are clinical clues that raise suspicion for gestational diabetes and warrant glucose testing. Normal fetal heart rate and modest weight gain do not suggest abnormal glucose metabolism.

Question 2Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A pregnant patient at 32 weeks reports regular painful contractions and low back pain. Which initial bedside assessment best distinguishes true preterm labor from false labor?

  1. Presence of bloody show alone
  2. Serial cervical examinations showing progressive dilation and effacement Correct answer.
  3. Maternal perception of contraction intensity
  4. Fetal movement counting over two hours

Explanation

True preterm labor is defined by regular contractions accompanied by progressive cervical change, so serial examinations documenting dilation and effacement are the key discriminator. Symptoms and perceived intensity alone are unreliable because Braxton Hicks contractions can be regular and uncomfortable.

Question 3Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which medication is the preferred first-line agent for acute seizure control in eclampsia?

  1. Hydralazine
  2. Magnesium sulfate Correct answer.
  3. Nifedipine
  4. Labetalol

Explanation

Magnesium sulfate is the drug of choice for preventing and treating eclamptic seizures and is superior to other anticonvulsants. The antihypertensives listed treat severe hypertension but do not control seizures.

Question 4Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient at 34 weeks has painless bright red vaginal bleeding and a soft, non-tender uterus. Which condition should be suspected first?

  1. Uterine rupture
  2. Placenta previa Correct answer.
  3. Vasa previa
  4. Abruptio placentae

Explanation

Painless third-trimester bleeding with a soft, non-tender uterus is the classic presentation of placenta previa. Abruption typically produces painful bleeding with a firm, tender uterus.

Question 5Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which parameter is the most sensitive indicator of acute fetal acidemia during intrapartum electronic monitoring?

  1. Baseline tachycardia of 165 beats per minute
  2. Recurrent late decelerations Correct answer.
  3. Baseline variability of 10 to 25 beats per minute
  4. Presence of a single acceleration

Explanation

Recurrent late decelerations reflect uteroplacental insufficiency and are the most concerning deceleration pattern for evolving fetal acidemia. Moderate variability is reassuring, and isolated tachycardia or a single acceleration is less specific.

Question 6Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient with preeclampsia without severe features at 37 weeks is being counseled. Which management is most appropriate?

  1. Immediate cesarean delivery regardless of cervical status
  2. Weekly amniocentesis until delivery
  3. Delivery is recommended at this gestational age Correct answer.
  4. Expectant management until 41 weeks

Explanation

For preeclampsia without severe features, delivery at 37 weeks or later is recommended to reduce maternal progression to severe disease without increasing neonatal morbidity substantially. Expectant management beyond term raises maternal risk.

Question 7Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which test is used to assess fetal lung maturity when late-preterm delivery is being considered?

  1. Maternal serum alpha-fetoprotein
  2. Phosphatidylglycerol or lecithin-to-sphingomyelin ratio on amniotic fluid Correct answer.
  3. Contraction stress test
  4. Nonstress test

Explanation

Lung maturity is assessed by amniotic fluid phospholipid markers such as the lecithin-to-sphingomyelin ratio and phosphatidylglycerol. The other tests evaluate fetal oxygenation or neural tube defects rather than pulmonary maturation.

Question 8Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient at 30 weeks presents with a fundal height of 24 cm. Which is the most appropriate next step?

  1. Immediate cesarean delivery
  2. Ultrasound assessment of fetal growth and amniotic fluid Correct answer.
  3. Maternal serum screening for aneuploidy
  4. Reassurance and recheck in four weeks

Explanation

A fundal height lagging more than 2 to 3 cm behind dates suggests fetal growth restriction or oligohydramnios and warrants ultrasound evaluation. Repeat measurement in four weeks would delay diagnosis of a potentially progressive condition.

Question 9Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which maternal condition is most strongly associated with an increased risk of preterm premature rupture of membranes?

  1. Prior cervical cone biopsy Correct answer.
  2. Chronic hypertension
  3. Gestational diabetes
  4. Mild iron-deficiency anemia

Explanation

Cervical surgery such as cone biopsy compromises cervical integrity and length, increasing the risk of preterm premature rupture of membranes and preterm birth. The other conditions are not established causes of membrane rupture.

Question 10Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient with type 1 diabetes is planning pregnancy. Which intervention before conception most reduces the risk of congenital malformations?

  1. Discontinuing insulin during the first trimester
  2. Beginning folic acid at 4 mg daily
  3. Starting low-dose aspirin
  4. Achieving tight glycemic control with an HbA1c near target Correct answer.

Explanation

Congenital malformation risk correlates with periconceptional glycemic control, so optimizing HbA1c before conception is the most important preventive step. High-dose folic acid reduces neural tube defects but does not address the broader malformation risk from hyperglycemia.

Question 11Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which finding is most consistent with severe features of preeclampsia?

  1. Platelet count of 90,000 per microliter Correct answer.
  2. 1+ proteinuria on dipstick
  3. Mild ankle edema
  4. Blood pressure of 138/88 mmHg

Explanation

Thrombocytopenia below 100,000 per microliter is one of the severe features of preeclampsia, along with elevated liver enzymes, renal insufficiency, pulmonary edema, and severe-range blood pressure. Mildly elevated pressure, low-grade proteinuria, and dependent edema are not severe features.

Question 12Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient at 26 weeks has a short cervix of 18 mm on transvaginal ultrasound. Which intervention reduces the risk of preterm birth?

  1. Cervical cerclage for all patients
  2. Empiric antibiotics for bacterial vaginosis
  3. Vaginal progesterone Correct answer.
  4. Bed rest

Explanation

Vaginal progesterone is recommended for patients with a short cervix in the midtrimester to reduce preterm birth risk. Cerclage is reserved for specific histories or exam-indicated cases, and bed rest has not been shown to be beneficial.

Question 13Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which is the most common cause of postpartum hemorrhage?

  1. Coagulopathy
  2. Retained placenta
  3. Genital tract laceration
  4. Uterine atony Correct answer.

Explanation

Uterine atony accounts for the majority of postpartum hemorrhage cases because the uterus fails to contract and compress bleeding vessels. The other causes are important but less frequent contributors.

Question 14Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient at 39 weeks has an intrauterine fetal demise. Which laboratory test is most important to obtain before delivery to guide management?

  1. Maternal serum alpha-fetoprotein
  2. Fetal fibronectin
  3. Maternal coagulation studies including fibrinogen Correct answer.
  4. Salivary estriol

Explanation

After fetal demise, coagulopathy can develop from release of thromboplastin, so coagulation studies including fibrinogen should be assessed before delivery. The other tests are not used to evaluate maternal coagulation status in this setting.

Question 15Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which condition is associated with the highest risk of maternal mortality if untreated?

  1. Gestational hypertension at term
  2. Mild preeclampsia at 38 weeks
  3. Chronic hypertension with normal renal function
  4. Eclampsia Correct answer.

Explanation

Eclampsia carries substantial maternal mortality and morbidity from seizures, aspiration, and intracranial hemorrhage, and requires immediate magnesium therapy and delivery planning. The other conditions are less acutely dangerous when appropriately managed.

Question 16Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient at 33 weeks presents with contractions, and a fetal fibronectin test is negative. What is the most appropriate interpretation?

  1. The negative result has a strong negative predictive value for delivery within seven days Correct answer.
  2. The negative result requires immediate delivery
  3. The negative result confirms chorioamnionitis is absent
  4. The negative result indicates the fetus is growth restricted

Explanation

A negative fetal fibronectin result has a high negative predictive value for delivery within about seven days, supporting expectant management. It does not diagnose infection, growth restriction, or mandate delivery.

Question 17Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which is a recognized maternal complication of placenta accreta spectrum at delivery?

  1. Spontaneous preterm labor
  2. Hyperemesis gravidarum
  3. Gestational diabetes
  4. Massive hemorrhage requiring hysterectomy Correct answer.

Explanation

Placenta accreta spectrum involves abnormal trophoblast invasion and failure of placental separation, causing life-threatening hemorrhage that often necessitates hysterectomy. The other conditions are unrelated to accreta pathophysiology.

Question 18Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A patient with a prior classical cesarean delivery at 36 weeks reports sudden severe abdominal pain and fetal bradycardia. What is the most likely diagnosis?

  1. Round ligament pain
  2. Placental abruption
  3. Preterm labor
  4. Uterine rupture Correct answer.

Explanation

Sudden severe pain with fetal bradycardia in a patient with a prior classical cesarean scar is highly concerning for uterine rupture, which requires emergency laparotomy and delivery. Abruption can cause pain and fetal compromise but lacks the scar-specific risk profile.

Question 19Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which fetal heart rate pattern is considered category III by the three-tier system?

  1. Marked variability without decelerations
  2. Baseline of 140 beats per minute with early decelerations
  3. Moderate variability with accelerations
  4. Absent variability with recurrent late decelerations Correct answer.

Explanation

Category III includes absent variability with recurrent late or variable decelerations, or a sinusoidal pattern, and signals abnormal fetal acid-base status requiring urgent evaluation. Patterns with moderate variability and accelerations are category I.

Question 20Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which intervention is recommended for a patient with preeclampsia with severe features at 34 weeks to reduce maternal morbidity?

  1. Immediate delivery without corticosteroids
  2. Outpatient blood pressure monitoring
  3. Expectant management until 39 weeks
  4. Antenatal corticosteroids followed by delivery after 24 to 48 hours Correct answer.

Explanation

At 34 weeks with severe features, antenatal corticosteroids are given to promote fetal lung maturity, and delivery follows after a 24- to 48-hour window if the mother is stable. Expectant management to 39 weeks is unsafe in severe disease.

Question 21Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which mechanism best explains how maternal smoking increases the risk of fetal growth restriction?

  1. Reduced uteroplacental blood flow from vasoconstriction and carbon monoxide Correct answer.
  2. Increased maternal plasma volume
  3. Elevated maternal oxygen saturation
  4. Enhanced placental glucose transport

Explanation

Smoking causes vasoconstriction and carbon monoxide exposure, reducing oxygen delivery to the fetus and impairing uteroplacental perfusion, which contributes to growth restriction. It does not increase plasma volume or oxygen saturation.

Question 22Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which is the most appropriate initial management for a patient at 28 weeks with preterm premature rupture of membranes and no evidence of infection?

  1. Hospitalization with antibiotics and antenatal corticosteroids Correct answer.
  2. Immediate induction of labor
  3. Outpatient management with weekly ultrasound
  4. Tocolytic therapy indefinitely

Explanation

Expectant management of PPROM before 34 weeks includes hospitalization, latency antibiotics, and antenatal corticosteroids to reduce neonatal morbidity. Immediate delivery is reserved for infection, abruption, or nonreassuring fetal status.

Question 23Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which condition is a contraindication to expectant management in a patient with preterm premature rupture of membranes at 30 weeks?

  1. Clinical chorioamnionitis Correct answer.
  2. Normal amniotic fluid index
  3. Cephalic presentation
  4. Maternal age over 35

Explanation

Clinical chorioamnionitis is a contraindication to continued expectant management because of the risk of maternal sepsis and fetal infection, so prompt delivery is indicated. Presentation, fluid volume, and maternal age do not preclude expectant care.

Question 24Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which screening approach is recommended for gestational diabetes in the first trimester for a patient with obesity and prior gestational diabetes?

  1. Early glucose tolerance testing with repeat testing at 24 to 28 weeks if normal Correct answer.
  2. Testing only if glycosuria is present
  3. No testing until 28 weeks
  4. Routine HbA1c alone at 12 weeks

Explanation

Patients with risk factors such as obesity or prior gestational diabetes should undergo early glucose testing, with repeat testing at 24 to 28 weeks if the early result is normal. Waiting until 28 weeks may miss preexisting diabetes.

Question 25Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

Which finding on a biophysical profile is assigned a score of 0?

  1. Two pockets of amniotic fluid measuring 2 cm each
  2. One acceleration of 15 beats per minute lasting 15 seconds
  3. Three body movements in 30 minutes
  4. A single episode of fetal breathing lasting 20 seconds in 30 minutes Correct answer.

Explanation

Fetal breathing must persist for at least 30 seconds within a 30-minute window to score 2 points; a 20-second episode scores 0. The other findings meet the criteria for full points.

Question 26Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A 32-year-old woman at 18 weeks gestation has a history of two prior preterm births. Which intervention is most effective in reducing the risk of another preterm birth?

  1. Bed rest and pelvic rest
  2. Cerclage placement
  3. Vaginal progesterone suppository
  4. Weekly intramuscular progesterone Correct answer.

Explanation

Intramuscular progesterone (17-alpha hydroxyprogesterone caproate) has been shown to reduce the risk of recurrent preterm birth in women with a history of spontaneous preterm birth. It is typically offered to women with a singleton gestation and prior preterm delivery. Cerclage is reserved for specific cervical insufficiency cases, and vaginal progesterone is used for short cervix without prior preterm birth.

Question 27Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A 28-year-old primigravida at 39 weeks is in active labor. The fetal heart rate tracing shows a baseline of 140 bpm with moderate variability, no accelerations, and recurrent late decelerations. Which is the most appropriate initial management?

  1. Increase oxytocin infusion
  2. Administer a tocolytic
  3. Reposition the patient and administer oxygen Correct answer.
  4. Perform an immediate cesarean delivery

Explanation

Recurrent late decelerations with moderate variability indicate possible uteroplacental insufficiency. Initial management includes maternal repositioning (left lateral), oxygen administration, and discontinuation of oxytocin if running. These measures aim to improve uteroplacental blood flow and fetal oxygenation.

Question 28Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A 35-year-old woman at 24 weeks gestation has a history of unexplained intrauterine fetal demise at 36 weeks in a previous pregnancy. She is currently on low-dose aspirin. Which additional intervention is recommended to reduce the risk of recurrent stillbirth?

  1. Daily fetal movement counting
  2. Prophylactic heparin
  3. Antepartum fetal surveillance starting at 32 weeks Correct answer.
  4. Serial growth ultrasounds

Explanation

Women with a prior stillbirth are at increased risk of recurrence. Antepartum fetal surveillance, such as weekly biophysical profile or nonstress test, is often initiated at 32 weeks or earlier based on individual risk factors. This allows early detection of fetal compromise and timely intervention.

Question 29Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A 30-year-old woman at 12 weeks gestation with type 1 diabetes has a hemoglobin A1c of 9.5%. Which congenital anomaly is most strongly associated with poor glycemic control in early pregnancy?

  1. Renal agenesis
  2. Cleft lip and palate
  3. Congenital heart defects Correct answer.
  4. Neural tube defects

Explanation

Poor glycemic control around conception and in early pregnancy increases the risk of congenital anomalies, with cardiac defects being the most common. Hyperglycemia is teratogenic, and the risk correlates with the degree of hyperglycemia. Neural tube defects are also increased but less common than cardiac anomalies.

Question 30Antepartum and Intrapartum Care of the High-Risk Mother and Fetus

A 38-year-old woman at 34 weeks gestation presents with severe preeclampsia. She is started on magnesium sulfate for seizure prophylaxis. Which parameter is most important to monitor to prevent magnesium toxicity?

  1. Urine output
  2. Respiratory rate
  3. Serum magnesium levels
  4. Deep tendon reflexes Correct answer.

Explanation

Deep tendon reflexes are the most sensitive clinical indicator of magnesium toxicity; they are lost early, before respiratory depression occurs. Serum magnesium levels are not routinely monitored because they do not correlate well with clinical toxicity. Urine output and respiratory rate are also monitored but are less sensitive for early toxicity.

Question 31Resuscitation and Stabilization of the Newborn

Immediately after birth, which action should be performed first for a vigorous term newborn with clear amniotic fluid?

  1. Begin positive-pressure ventilation with a self-inflating bag
  2. Obtain a heel-stick blood gas sample
  3. Provide warmth and dry the infant under a radiant warmer Correct answer.
  4. Perform chest compressions coordinated with ventilations

Explanation

The initial steps of newborn resuscitation prioritize maintaining warmth, drying the skin, and stimulating breathing. A vigorous newborn with clear fluid generally needs only these routine steps before assessment of breathing and heart rate. More invasive interventions are reserved for infants who remain apneic or bradycardic after initial stabilization.

Question 32Resuscitation and Stabilization of the Newborn

During newborn resuscitation, which device is preferred for delivering positive-pressure ventilation to a term infant?

  1. A neonatal self-inflating bag with a pop-off valve
  2. A T-piece resuscitator with a set peak inspiratory pressure Correct answer.
  3. A flow-inflating bag without a pressure gauge
  4. Mouth-to-mouth breathing with a barrier device

Explanation

A T-piece resuscitator allows precise control of peak inspiratory pressure and positive end-expiratory pressure, which reduces the risk of excessive volume or pressure injury. It is widely recommended for newborns requiring respiratory support at delivery. Consistent pressure delivery is especially important in preterm infants with immature lungs.

Question 33Resuscitation and Stabilization of the Newborn

A newborn is apneic and bradycardic at one minute after birth. What is the most appropriate initial ventilation rate for positive-pressure ventilation?

  1. 80 to 100 breaths per minute
  2. 20 to 30 breaths per minute
  3. 40 to 60 breaths per minute Correct answer.
  4. 10 to 20 breaths per minute

Explanation

Positive-pressure ventilation for a newborn should be delivered at approximately 40 to 60 breaths per minute. This rate supports adequate minute ventilation while allowing time for exhalation. Rates that are too slow provide insufficient gas exchange, and rates that are too fast impair venous return.

Question 34Resuscitation and Stabilization of the Newborn

When should chest compressions be initiated during newborn resuscitation?

  1. When the oxygen saturation is below 90 percent on pulse oximetry
  2. When the heart rate is below 60 beats per minute despite effective ventilation Correct answer.
  3. When the heart rate is below 100 beats per minute with spontaneous breathing
  4. When the infant has not cried within the first 30 seconds

Explanation

Chest compressions are indicated when the heart rate remains below 60 beats per minute after at least 30 seconds of effective positive-pressure ventilation. Ventilation must be optimized first because bradycardia in newborns usually reflects hypoxemia. Compressions are delivered with a 3:1 compression-to-ventilation ratio in neonates.

Question 35Resuscitation and Stabilization of the Newborn

Which technique is recommended for delivering chest compressions to a newborn?

  1. Two-thumb encircling technique over the lower third of the sternum Correct answer.
  2. Two-finger technique over the lower third of the sternum
  3. Four-finger technique over the upper sternum
  4. Single-hand technique over the mid-sternum

Explanation

The two-thumb encircling technique is preferred because it generates more consistent pressure and depth and allows better control of the chest. Thumbs are placed on the lower third of the sternum just below the nipple line. The two-finger technique is an alternative when the rescuer's hands are too small or access is limited.

Question 36Resuscitation and Stabilization of the Newborn

What compression-to-ventilation ratio is used during neonatal cardiopulmonary resuscitation?

  1. 15:2
  2. 30:2
  3. 3:1 Correct answer.
  4. 5:1

Explanation

Neonatal resuscitation uses a 3:1 ratio of compressions to ventilations, giving 90 compressions and 30 breaths per minute. This ratio reflects the primarily respiratory cause of neonatal arrest and emphasizes ventilation. Adult and older pediatric ratios differ because their arrest mechanisms are more often cardiac.

Question 37Resuscitation and Stabilization of the Newborn

Which medication is indicated for a newborn with bradycardia that persists despite effective ventilation and chest compressions?

  1. Epinephrine Correct answer.
  2. Atropine
  3. Naloxone
  4. Sodium bicarbonate

Explanation

Epinephrine is recommended when the heart rate remains below 60 beats per minute despite adequate ventilation and coordinated chest compressions. It is typically given intravenously or intraosseously at a dose of 0.01 to 0.03 mg/kg of the 0.1 mg/mL concentration. Its alpha-adrenergic effects increase coronary and cerebral perfusion.

Question 38Resuscitation and Stabilization of the Newborn

What is the recommended initial oxygen concentration for resuscitating a term newborn?

  1. 30 percent
  2. 100 percent
  3. 50 percent
  4. 21 percent (room air) Correct answer.

Explanation

Term newborns should initially receive room air (21 percent oxygen) during resuscitation. Oxygen concentration is then titrated based on preductal oxygen saturation targets and clinical response. Using excessive oxygen early can cause oxidative stress and is avoided when possible.

Question 39Resuscitation and Stabilization of the Newborn

A preterm infant at 28 weeks gestation is delivered and requires respiratory support. Which measure best reduces heat loss immediately after birth?

  1. Bathing the infant promptly to remove amniotic fluid
  2. Using a plastic wrap or bag with a hat and warm blankets under a warmer Correct answer.
  3. Placing the infant under a radiant warmer without a plastic wrap
  4. Delaying any thermal intervention until the infant is stabilized

Explanation

Preterm infants lose heat rapidly through evaporation, conduction, and radiation because of their thin skin and poor thermoregulation. Placing the infant in a plastic wrap or bag under a radiant warmer, with a hat and warm blankets, reduces evaporative and convective losses. Maintaining normothermia improves survival and reduces metabolic stress.

Question 40Resuscitation and Stabilization of the Newborn

During positive-pressure ventilation, an infant's chest is not rising and breath sounds are absent on the left. What is the most appropriate next step?

  1. Reposition the head and check mask seal and airway patency Correct answer.
  2. Administer epinephrine intravenously
  3. Begin chest compressions immediately
  4. Increase the peak inspiratory pressure substantially

Explanation

When the chest does not rise during positive-pressure ventilation, the rescuer should follow a systematic approach to airway and device problems. Repositioning the head to open the airway, checking the mask seal, and verifying patency address the most common causes. Increasing pressure before correcting these issues risks barotrauma.

Question 41Resuscitation and Stabilization of the Newborn

A newborn receives effective positive-pressure ventilation, but the heart rate remains 50 beats per minute after 45 seconds. What should be done next?

  1. Start chest compressions with a 3:1 ratio and coordinate with ventilation Correct answer.
  2. Discontinue ventilation and begin cardiac monitoring
  3. Continue ventilation alone and reassess in two minutes
  4. Increase the ventilation rate to 100 breaths per minute

Explanation

A heart rate below 60 beats per minute after at least 30 seconds of effective ventilation is the indication to begin chest compressions. Compressions should be coordinated with ventilation at a 3:1 ratio. Reassessment occurs approximately every 60 seconds while resuscitation continues.

Question 42Resuscitation and Stabilization of the Newborn

Which finding best indicates that positive-pressure ventilation is effective in a newborn?

  1. Audible gas escape around the mask
  2. Rising heart rate and improving oxygen saturation Correct answer.
  3. Visible abdominal distension
  4. A fall in heart rate during inflation

Explanation

Effective ventilation is confirmed by a rising heart rate, improving oxygen saturation, and visible chest movement. The heart rate is the most sensitive indicator of successful ventilation in newborns. A falling heart rate suggests inadequate ventilation or another complication.

Question 43Resuscitation and Stabilization of the Newborn

A newborn born through meconium-stained amniotic fluid is nonvigorous with poor respiratory effort. What is the recommended approach?

  1. Delay all intervention and observe for spontaneous improvement
  2. Suction the mouth and nose vigorously before drying the infant
  3. Dry and stimulate the infant, then provide positive-pressure ventilation if breathing remains inadequate Correct answer.
  4. Perform immediate intubation and suction the trachea before any drying

Explanation

Current guidance recommends initial drying and stimulation for nonvigorous infants with meconium-stained fluid, followed by positive-pressure ventilation if needed. Routine intubation and tracheal suctioning are not recommended for nonvigorous infants because they may delay ventilation. Endotracheal suctioning is reserved for suspected airway obstruction.

Question 44Resuscitation and Stabilization of the Newborn

Which oxygen saturation target is appropriate for a term newborn at 5 minutes after birth when pulse oximetry is used?

  1. 96 to 100 percent
  2. 70 to 80 percent
  3. 50 to 60 percent
  4. 85 to 95 percent Correct answer.

Explanation

Preductal oxygen saturation targets rise gradually after birth, reaching approximately 85 to 95 percent by 5 minutes. These targets guide titration of supplemental oxygen and help avoid both hypoxia and hyperoxia. Saturations are measured on the right hand or wrist to reflect preductal values.

Question 45Resuscitation and Stabilization of the Newborn

A newborn requires intravenous epinephrine during resuscitation. Which dose and concentration are correct?

  1. 0.1 to 0.3 mg/kg of the 1 mg/mL concentration
  2. 0.01 to 0.03 mg/kg of the 0.1 mg/mL concentration Correct answer.
  3. 0.5 mg/kg of the 1 mg/mL concentration
  4. 1 mg/kg of the 0.1 mg/mL concentration

Explanation

The recommended intravenous or intraosseous dose of epinephrine in neonatal resuscitation is 0.01 to 0.03 mg/kg using the 0.1 mg/mL concentration. This equals 0.1 to 0.3 mL/kg of the diluted solution. Higher doses or concentrations risk hypertension, tachycardia, and myocardial injury.

Question 46Resuscitation and Stabilization of the Newborn

Which condition most strongly suggests that a newborn requires prolonged resuscitation and possible therapeutic hypothermia evaluation?

  1. Transient mild cyanosis resolving with drying
  2. Need for continued chest compressions at 10 minutes after birth Correct answer.
  3. Cord blood gas with pH 7.35
  4. Apgar score of 8 at 5 minutes

Explanation

Infants who require continued chest compressions or resuscitation at 10 minutes after birth are at high risk for hypoxic-ischemic encephalopathy. Such infants should be evaluated for therapeutic hypothermia within the recommended time window. Early identification allows timely transfer to a cooling center.

Question 47Resuscitation and Stabilization of the Newborn

What is the appropriate management of a newborn with a heart rate below 60 beats per minute that persists despite ventilation and compressions, when vascular access is unavailable?

  1. Administer epinephrine intramuscularly
  2. Administer epinephrine via the endotracheal tube at a higher dose Correct answer.
  3. Wait for intravenous access before giving any medication
  4. Administer epinephrine subcutaneously

Explanation

When vascular access cannot be established promptly, epinephrine may be given via the endotracheal tube at a higher dose than the intravenous route. Absorption from the lungs is less predictable, so a larger dose is used. Intravenous or intraosseous access remains preferred and should be obtained as soon as possible.

Question 48Resuscitation and Stabilization of the Newborn

A newborn is born limp and apneic after a pregnancy complicated by maternal opioid use. Which intervention is most appropriate first?

  1. Give intravenous epinephrine
  2. Administer naloxone intramuscularly immediately
  3. Perform gastric lavage to remove the opioid
  4. Provide effective positive-pressure ventilation and support Correct answer.

Explanation

The priority in an apneic newborn, regardless of suspected opioid exposure, is effective ventilation and circulatory support. Naloxone is not recommended as a first step in the delivery room because ventilation reverses hypoxia more reliably. Naloxone may be considered later in confirmed opioid-induced respiratory depression once ventilation is established.

Question 49Resuscitation and Stabilization of the Newborn

Which statement best describes the role of delayed cord clamping in a term newborn who does not require resuscitation?

  1. It is contraindicated in all deliveries
  2. It should be avoided because it increases the risk of jaundice requiring treatment
  3. It improves iron stores and is recommended for at least 30 to 60 seconds after birth Correct answer.
  4. It should be performed only after the cord stops pulsating for 10 minutes

Explanation

Delayed cord clamping for at least 30 to 60 seconds improves neonatal iron stores and is recommended for term infants not requiring resuscitation. It may modestly increase the risk of jaundice, but the benefits generally outweigh this in healthy term infants. The infant should be kept warm and observed during the delay.

Question 50Resuscitation and Stabilization of the Newborn

A 32-week preterm infant is receiving positive-pressure ventilation with a T-piece resuscitator. Which initial settings are most appropriate?

  1. Peak inspiratory pressure of 30 cm H2O and positive end-expiratory pressure of 15 cm H2O
  2. Peak inspiratory pressure of 20 to 25 cm H2O and positive end-expiratory pressure of 5 cm H2O Correct answer.
  3. Peak inspiratory pressure of 40 cm H2O and positive end-expiratory pressure of 0 cm H2O
  4. Peak inspiratory pressure of 10 cm H2O and positive end-expiratory pressure of 10 cm H2O

Explanation

Initial ventilation for a preterm infant typically uses a peak inspiratory pressure of about 20 to 25 cm H2O and positive end-expiratory pressure of about 5 cm H2O. These settings aim to recruit alveoli while minimizing volutrauma and barotrauma. Pressures are then adjusted based on chest rise, heart rate, and oxygen saturation.