Nursery+Quiz


 * 1) A typical situation when a baby may need to be supplemented or fed with formula is:**

a) Inverted nipples b) Delayed milk production c) Dehydration d) A + C e) B + C f) All of the above.

a) Breastfeeding not going well. b) Breast milk. c) Rh incompatibility. d) Coombs positive. e) A,b,c f) All of the above.
 * 2) The causes of hyperbilirubinemia include:**

a) D10W + 3mEq NaCl/100ml + 2mEq KCl/100ml b) D5W ½ NS + 20KCl/L c) D10W + 4mEq NaCl/100ml +2mEq KCl/100ml d) LR at 100ml/day
 * 3) Typical maintenance fluids for a 3 day old term newborn are:**

a) Intra-partum treatment with penicillin, at least 3 doses. b) Intra-partum treatment with penicillin, at least 1 dose 4 hours prior to delivery. c) 48 hour treatment of baby with ampicillin and gentamicin. d) All of the above. e) B + C
 * 4) How can early-onset GBS disease be prevented?**

a) Nothing, maybe Tylenol for pain. b) Splinting. c) Sling. d) Cast.
 * 5) What is the treatment of clavicle fracture?**

a) Cannot be differentiated. b) Caput succedaneum crosses suture lines. c) Caput succedaneum is fluctuant. d) Skull X-ray.
 * 6) How do you differentiate a Caput succedaneum from a cephalhematoma?**

a) Benign is soft, pathological is harsh. b) Systolic murmurs are usually benign. c) Murmurs that radiate are usually pathological. d) Sometimes it is hard to say and further evaluation is necessary.
 * 7) What are the characteristics of murmurs that distinguish pathologic from benign murmurs?**

a) Maternal diabetes. b) Trisomy 21 c) Trisomy 18 d) Sibling with VSD e) A + D f) A + C g) All of the above
 * 8) What are risk factors for congenital heart defects?**

a) When you hear a murmur. b) When a baby is tachypneic after birth. c) When an ECG that you ordered shows RVH and superior left axis deviation. d) When the baby has a “funny” cry.
 * 9) When should you refer a patient to the cardiologist?**

a) Grunting and flaring. b) Not breast feeding. c) An enlarged liver. d) A heart rate of 190/min. e) A respiratory rate of 120/min. f) Cyanosis. g) Intra- and subcostal retractions. h) All of the above. i) a + e + f + g j) b + c + g
 * 10) What are signs of respiratory distress?**

a) Meconium destroys surfactant in the lungs. b) Meconium plugs up little bronchioles c) Meconium aspiration can lead to left-to-right shunt and pulmonary hypertension. d) Meconium leads to inflammation. e) A + C f) All of the above
 * 11) Why does meconium aspiration lead to respiratory problems?**

a) Intubate immediately. b) Mouth-to-mouth resuscitation c) Vigorously slap the buttocks. d) Stimulation, if baby does not respond within 20 seconds start PPV e) Massage “kidney one”, which is a powerful acupressure point that stimulates breathing.
 * 12) A newborn baby is not breathing and the heart rate is 60/min. What do you do?**

a) Start a chemstick protocol. b) Not start a chemstick protocol because the mother is not diabetic. c) Watch the baby clinically and only do a chemstick when the baby is jittery. d) Forget about the chemsticks and breast feed immediately.
 * 13) A baby is born to a morbidly obese mother and weighs 4800 grams. The mother is not known to have gestational diabetes. You are supposed to:**

a) Call the attending. b) Ask the nurse what you should do. c) Wish that you had not returned the page. d) Recommend early feeding with a mixture of 40% D25W, 20% D10W and the rest formula. e) Order putting in a PIV, give a bolus of D10W (2-3ml/kg) and continue with a continuous D10W infusion, running at 80ml/kg/day. f) All of the above.
 * 14) A baby is born to a mother with gestational diabetes, who is on metformin. The nurse calls you and tells you that the blood sugar of the baby is 25 mg/dl. What would you do?**

a) Do nothing because 46 mg/dl is normal. b) Start an iv immediately and give a D10W bolus. c) Start an iv immediately and give an LR bolus of 3 ml/kg. d) Try “early feeding” with a mixture of D10W and infant formula.
 * 15) The nurse calls you and tells you that a newborn baby has a blood sugar of 46mg/dl. What would you recommend?**

a) Mother is an alcoholic and did not drink enough alcohol before delivery; now the baby is experiencing seizures. b) The baby is showing symptoms of withdrawal from opiates. c) The baby is showing symptoms of withdrawal from methamphetamines. d) The baby is showing symptoms of withdrawal from SSRIs. e) All of the above. f) B + C +D
 * 16) What is, strictly speaking, “neonatal abstinence syndrome?”**

a) You should not have used methadone because your baby is suffering now. b) I will call CPS immediately because you are obviously an unfit mother. c) The baby will be treated with morphine as needed so the baby will not suffer. The hospital stay will likely be between 4 and 6 weeks. d) I discourage from breast feeding because methadone is bad for the baby.
 * 17) A baby is expected to withdraw from methadone. You should tell the parents the following:**

a) The baby is ready because the insurance only pays for a 3 day stay if it is a vaginal delivery. b) The baby can go home when the feeding is established. c) You would like to confirm the gestational age before answering the question. d) A +B e) B + C
 * 18) You have a late preterm infant in your nursery. The baby is 3 days old now. The parents ask you when the baby is ready to go home. You tell them that:**

a) Breast feeding ad lib. b) NPO for at least 24 hours and ivF. c) Likely needs an iv, but can try to breastfeed and should definitely do skin-to-skin as much as possible and tolerated. d) 34-weekers should never breastfeed and you need to order “Premature Enfamil 24 kcal/oz.”
 * 19) You are admitting a 34 week late preterm infant to the nursery. The nurse asks you to write feeding orders.**

a) It is a “stamina test” to see if the baby can sustain good saturations in the car seat. b) It is necessary to determine the right size for the car seat. c) Babies are put in the car seat to take a family picture. d) There is no such thing as a “car seat study.”
 * 20) What is a car seat study for?**

a) All babies under 36 weeks gestational age should be put on Fe and Polyvisol. b) Only babies with a hematocrit of less than 40% should get iron and polyvisol. c) You should only give Fe and Polyvisol if absolutely necessary because there are numerous side effects. d) It is up to you whether you give it or not.
 * 21) Iron and Polyvisol are frequently given to late preterm infants. The indications are:**

a) You tell her that she does not need to freak out because bilirubin is an antioxidant and actually good for you. b) You tell her to start triple phototherapy immediately and you will be over in the nursery in a few minutes. c) You give her a telephone order to start an infusion of ivIg immediately. d) You panic and call the attending. e) You do not panic but call the pediatric attending to discuss this case. f) You give her a telephone order to repeat bilirubin in 4 hours. g) B + e h) B + c + d
 * 22) The nurse calls you and tells you that a baby’s bilirubin level is 30 mg/dl at 44 hours of life.**

a) You send the baby home and make a nursery appointment in 24 hours to recheck the bilirubin level. b) You reassure the parents. c) You do not believe the lab result and order a repeat. d) You start Phototherapy.
 * 23) A baby looks somewhat yellow and you order a total and direct bilirubin. The total bilirubin is 5.5 mg/dl and the direct is 0.4 mg/dl at 36 hours. Mom’s blood type is A+.**

a) You discontinue phototherapy and check another bilirubin level 8 – 10 hours later. b) You discontinue phototherapy and send the baby home. c) You continue to do phototherapy until the bilirubin level is down to 5 mg/dl. d) You send the baby home with home phototherapy.
 * 24) A baby is under phototherapy for jaundice secondary to ABO incompatibility. You recheck the bili level and it comes back as 11.2 mg/dl at 48 hours. Phototherapy was started at 17.9 mg/dl**

a) Nothing in particular because they are pretty mature. b) Feeding difficulties. c) Temperature instability. d) Respiratory distress. e) Low blood sugars. f) Lower IQs in later life. g) Lifelong breathing difficulties. h) B,c,d,f i) B,e j) All of the above.
 * 25) Late preterm infants are at risk to experience:**