CHCONNP Procedural Skills 2016

1.

An indication for endotracheal intubation in the neonate includes:

Suctioning the trachea in an infant delivered with meconium stained amniotic fluid

Apnea and bradycardia of prematurity

Need for prolonged positive pressure ventilation

2.

A situation in which it may be appropriate to intubate a neonate WITHOUT premedication is:

During initial resuscitation

Non-emergent intubation for worsening respiratory distress

A premature infant with apnea of prematurity

3.

When using the "tip to lip" rule, an infant weighing 2.5kg should have the ETT advanced to the ___ centimeter marking on the ETT.

8cm

8.5cm

7cm

4.

Appropriate technique for placement of an ETT in a neonate includes:

Holding the laryngoscope in the right hand

Positioning the infant with neck hyperextended

Holding the ETT in the right hand

5.

Laryngeal mask airway placement is appropriate in the neonate:

Requiring high ventilation pressures

When attempts at intubation are not effective or considered not feasable

That weighs less than 2kg

6.

A primary indication for UAC placement include:

Need for frequent blood gases

Need for antibiotic administration for greater than 7 days

Need for an exchange transfusion

7.

A UAC placed in the "high" position:

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

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

Should be located between T6 and T9 on x-ray

8.

Contraindications to PAL placement in a neonate include:

Untreated anemia

Mild thrombocytopenia

Evidence of circulatory compromise in the extremity chosen for placement

9.

Indications for PAL placement in the neonate include:

Need for routine daily labs

Need for pre and postductal saturation monitoring

Need for continuous monitoring of central blood pressure

10.

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

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

The "right in" technique

The "right through" technique

11.

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

Radial artery

Ulnar artery

Dorsalis pedis artery

12.

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

Angled around the bladder toward the iliac artery

Passed through the ductus venosus into the inferior vena cava

Wedged in an intrahepatic branch of the umbilical vein

13.

Optimal placement of a UVC in a neonate is:

Just above the diaphragm at ~T8

Just below the diaphragm at ~T9-T10

T6-T10

14.

An indication for PICC placement in the neonate is:

An anticipated 48 hour rule-out for infection

Anticipated long term antibiotic therapy

NICU RN not comfortable with PIV insertion

15.

The 'gold standard' for confirmation of PICC placement in a neonate is:

X-ray confirming desired placement

Abundant blood return during insertion of the catheter

Easy insertion of catheter to desired depth

16.

A common complication of a PICC is:

Infection

Loss of perfusion distal to insertion site

Extravascular collection of fluid

17.

A contraindication to PICC placement is:

Platelet count less than 100,000

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

Untrained personnel attempting insertion

18.

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

Evaluate the degree of IVH

Aid in the diagnosis of CNS infections

Determine length of antibiotic treatment in blood sepsis

19.

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

Be patient and wait to see if the CSF will flow

Aspirate to see if you can obtain CSF

Continue to advance and withdrawal the needle until you obtain flow

20.

A common complication from a LP in the neonate is:

Infection

Transient hypoxia from positioning

Iatrogenic hypoxia with apnea and bradycardia requiring bag/mask ventilation

21.

In the late preterm neonate, the optimal insertion site for a LP is:

L4-L5 interspace

L3-L4 interspace

L2-L3 interspace

22.

Appropriate pain management for a thoracostomy tube placement includes:

Continuous Fentanyl drip

Sucrose on a pacifier

Fentanyl bolus

23.

An indication for a thoracostomy tube placement is:

Pleural fluid accumulation without hemodynamic changes

Tension pneumothorax

Small pneumothorax without hemodynamic changes

24.

Pigtail catheter placement is less invasive than the traditional trocar placement for thoracostomy.

True

False

25.

When performing a needle thoracostomy, the correct location to insert the needle for air removal is:

4th-5th midaxillary intercostal space

2nd midclavicular intercostal space

1st midaxillary intercostal space

26.

An indication for a double volume exchange transfusion in a neonate is:

Significant hyperbilirubinemia responsive to high intensity phototherapy

Significant hyperbilirubinemia unresponsive to high intensity phototherapy

Significant anemia of prematurity unresponsive to erythropoietin

27.

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

Hypocalcemia

Cardiac arrest

Death

28.

An indication for a partial exchange transfusion in a neonate is:

Polycythemia

Thrombocytopenia

Hyperbilirubinemia

29.

What is the appropriate volume to order for a double volume exchange transfusion for a term 2.5kg infant (with estimated tubing dead space of 25mL):

225mL

425mL

525mL

30.

Indication for obtaining intraosseous access in the neonate includes:

In the NICU when IV access is difficult

In a life threatening situation and IV access is unavailable

Need for IV access when the UVC is unavailable for antibiotic use

31.

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

Inserted on the anteromedial surface ~1-2cm below the tibial tuberosity

Directed toward the growth plate

Inserted at the tip of the anteromedial surface of the tibia

32.

If extravasation occurs at the site of the IO placement:

Adjust the needle 0.5cm superficially and restart infusion, observing for recurrenece

Adjust the needle 0.5cm deeper and restart infusion, observing for recurrence

Remove needle and attempt placement in another extremity

33.

Which of the following statements describe the proper technique in a pericardiocentesis:

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

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

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

34.

An indication for a pericardiocentesis in a neonate is:

Pneumothorax under tension

Pneumopericardium causing cardiac tamponade

Asymptomatic pericardial effusion

35.

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

True

False