CHCONNPS2015

1.

1 point

Which of the following statements describes the proper technique in a pericardiocentesis?

. The needle/cannula assembly should enter skin 0.5 to 1 cm above the tip of the xiphoid process

The needle/cannula assembly should enter 2 cm below the tip of the xiphoid process

The needle/cannula assembly should enter skin 0.5cm to 1cm below the tip of the xiphoid process

2.

1 point

An indication for PICC placement in a neonate is:

An anticipated 48 hour rule-out for infection in an infant

Anticipated long term antibiotic treatment

NICU RN is not comfortable with PIV insertion

3.

1 point

Appropriate technique for placement of an ET tube in a neonate includes:

Holding the laryngoscope in the right hand

Holding the endotracheal tube in the right hand

Positioning the infant with neck hyperextended to facilitate visualization of the vocal cords

4.

1 point

When performing an LP, if you believe your needle is in proper positioning, yet you have not received any CSF drainage, an appropriate response would be:

Continue to advance and withdrawal needle until you obtain flow

Aspirate to see if you can obtain CSF

Be patient and wait to see if CSF begins to flow

5.

1 point

A common complication due to a double volume exchange transfusion is:

Death

Cardiac Arrest

Hypocalcemia

6.

1 point

An indication for a partial exchange transfusion is:

Thrombocytopenia

Anemia

Polycythemia

7.

1 point

Which of the following statements is true regarding pain management for a pericardiocentesis?

Time should be taken to start an IV and give an opioid analgesia for this procedure

Local anesthetic 0.25 to 1 mL of 1% lidocaine instilled within 1-2 cm of the xiphoid process is appropriate for this procedure

Sucrose on a pacifier is appropriate analgesia for this procedure

8.

1 point

Indications for PAL placement in the neonate include:

Need for pre and post ductal oxygen saturation monitoring

Need for continuous monitoring of central blood pressure

Need for routine daily lab draws

9.

1 point

An indication for a double volume exchange transfusion is:

Significant anemia of prematurity unresponsive to erythropoietin

Significant unconjugated hyperbilirubinemia unresponsive to high intensity phototherapy

Significant unconjugated hyperbilirubinemia responsive to high intensity phototherapy

10.

1 point

If extravasation occurs at the site of the IO placement:

Adjust needle 0.5 cm deeper and restart infusion and observe for recurrence

Adjust needle 0.5 cm superficially and restart infusion and observe for recurrence

Remove needle and attempt placement in another extremity

11.

1 point

A lumbar puncture is not a painful procedure and should not require any additional pain management strategies other than swaddling.

True

False

12.

1 point

A contraindication to PICC placement is:

Untrained personnel attempting insertion

Platelet count of 100,000

History of a positive blood culture, followed by a negative blood culture

13.

1 point

Laryngeal mask airway placement in the neonate is contraindicated:

When the neonate is greater than 2kg

When the neonate is less than 2kg

When the neonate has congenital anomalies of the mouth, lip, or palate

14.

1 point

A UAC placed in the “high” line position:

Is associated with more blanching of the lower extremities than a “low” line

Should only be used if you are unable to place a “low” line

Is located between T6 and T9 on x-ray

15.

1 point

Final confirmation for appropriate tracheal placement of ETT includes

Appropriate ‘tip to lip’ measurement

CXR showing ETT approximately 1cm above carina

Auscultation of equal breath sounds bilaterally

16.

1 point

Placement of an intraosseous needle is not a sterile procedure since it is done in emergency situations only.

True

False

17.

1 point

An indication for thoracostomy tube placement includes:

Tension pneumothorax with hemodynamic changes

Pleural fluid accumulation without hemodynamic changes

Small pneumothorax without hemodynamic changes

18.

1 point

When using the “tip to lip” rule an infant weighing 2.5 kg should have the endotracheal tube advanced to the _______ centimeter marking on the endotracheal tube.

8.5 cm

7cm

8cm

19.

1 point

Pig tail catheter placement is less invasive and less painful than traditional trocar placement for thoracostomy.

True

False

20.

1 point

Contraindications for intraosseous access include:

IV infiltration in the chosen extremity

Use of proximal tibia site

Osteogensis imperfecta

21.

1 point

A common complication from a lumbar puncture in the neonate is:

Infection

Iatrogenic hypoxia with apnea and bradycardia requiring bag mask ventilation

Transient hypoxia from positioning

22.

1 point

An indication for a pericardiocentesis in a neonate is:

Pneumothorax under tension

Pneumopericaridium causing cardiac tamponade

Asymptomatic pericardial effusion

23.

1 point

Annual procedural review is a recommendation of the National Association of Neonatal Nurse Practitioners Competency Statement

True

False

24.

1 point

The recommended technique for PAL placement in the premature infant is:

The ‘right through’ technique

The ‘right in’ technique

Introduce needle at a 90 degree angle and advance at a right angle.

25.

1 point

Primary indications for UAC placement include:

Need for exchange transfusion

Need for antibiotic administration for greater than 7 days

Need for frequent blood gases

26.

1 point

To minimize airway compromise during performance of a lumbar puncture in the neonate:

Flex hips close to 180 degrees

Provide 90 degree neck flexion

Hold at shoulders and knees or buttocks

27.

1 point

Contraindications for lumbar puncture in the neonate include:

Decreased intracranial Pressure

Normal intracranial pressure

Increased intracranial Pressure

28.

1 point

When using the tibial tuberosity site for IO placement in the neonate the needle should be:

inserted at the tip of the anteromedial surface of the tibia

directed toward the growth plate

inserted on the anteromedial surface approximately 1-2 cm below the tibial tuberosity

29.

1 point

Laryngeal mask airway placement is appropriate in the neonate:

Always instead of endotracheal tube place since it is less invasive

When attempts at intubation are not effective or considered not feasible

When the neonate’s trachea requires suctioning due to meconium stained amniotic fluid

30.

1 point

Indication for obtaining intraosseous access in the neonate includes:

In the NICU when intravenous access is difficult

Need for IV access when Umbilical venous line is unavailable for antibiotic use

In life threatening situations and IV access is unavailable

31.

1 point

Contraindications to PAL placement in the neonate include:

Mild thrombocytopenia

Evidence of circulatory compromise in extremity chosen for PAL placement

Untreated anemia

32.

1 point

An Indication for endotracheal intubation in the neonate includes:

Suctioning the trachea in vigorous infants with meconium stained amniotic fluid

Apnea and bradycardia of prematurity

Need for prolonged positive pressure ventilation

33.

1 point

Appropriate pain management for thoracostomy tube placement includes:

Sucrose on a pacifier

Fentanyl bolus

Continuous Fentanyl drip

34.

1 point

If a UVC meets obstruction before advancement to the pre-measured insertion goal, it may have:

Passed through the ductus venous into the inferior vena cava

Wedged in an intrahepatic branch of the umbilical vein

Angled around bladder toward internal iliac artery

35.

1 point

In the preterm neonate the optimal site for lumbar puncture is:

L4- L5 Interspace

L3- L4 Interspace

L2-L3 Interspace

36.

1 point

The ‘gold standard’ for confirmation of PICC placement is:

X-ray confirming desired placement

Abundant blood return via catheter

Easy insertion of catheter to predetermined depth

37.

1 point

The most common site for PAL placement in the neonate is:

Ulnar artery

Dorsalis pedis artery

Radial artery

38.

1 point

An indication for obtaining CSF via a lumbar puncture in the neonate is to:

evaluate the degree of IVH in the neonate

obtain CSF to aid in the diagnosis of CNS disorders such as meningitis/encephalitis

determine length of antibiotic treatment in blood sepsis

39.

1 point

A common complication of a PICC line is:

Nerve damage from inappropriate insertion technique

Loss of perfusion distal to insertion site

Infection

40.

1 point

Pain management for the neonate during non-emergent intubation:

Can be accomplished with appropriate positioning during the procedure

Ideally would include a predetermined pharmacologic approach

Is rarely needed if the intubation is performed quickly and effectively