CCRN NEONATAL CERTIFICATION PRACTICE EX
g g g g
AM(LATEST ANNUAL AACN PRACTICE EXAM 20
g g g g g
22/2023)
Definegthegtermgdeformation
(correctganswers)abnormalitygcausedgbygunusualgmechanicalgforcesgongnormalgtissue.
Aglowgbirthgweightginfant'sgtemperaturegincreasesgduringgskin-to-
skingcare.gThisgisgangexamplegofgheatgtransfergby
(correctganswers)conduction.
Atgthegonsetgofglaborgthegreleasegofgcatecholaminesgstimulatesg(corr
ectganswers)increasedgabsorptiongofglunggfluid.
Angedematous,gbruisedglesiongongthegrightganteriorgscalpgwheregthegvacuumgwasgapplied.gThisglesiong
hasgclearlygdemarcatedgedges,gisgfirmgtogtouch,gandgdoesgnotgcrossgthegsuturegline.gThisgisgbestgdescrib
edgasgag(correctganswers)cephalohematoma.
Anginfantgborngatg40g5/7gweeksggestationgandgweighedg5glbsg2ozg(2,360ggrams).gIngcompletinggaggestat
ionalgagegassessmentgongthisginfant,gyougwouldgidentifyghergasg(correctganswers)term,gsmallgforggestati
onalgage.
,Duringgfetalglife,gthegductusgarteriosusg(correctganswers)divertsgbloodgflowgfromgthegpulmonarygarterygt
ogthegdescendinggaorta.
Expectedgfindingsgingagneonategborngtogagmothergwhogreceivedgmagnesiumgsulfateginglaborgincludeg(co
rrectganswers)hypotonia.
Eyegprophylaxisgwithgagsingle-
usegdosegofgsterilegophthalmicgointmentgcontainingg1%gtetracyclinegorg0.5%gerythromycingisgusuallygad
ministeredgwithingthegfirstgfewghoursgofgbirthgtogpreventgangeyeginfectiongcausedgbyg(correctganswers)
gonorrhea.
Followinggagbirthgcomplicatedgbygshouldergdystocia,gthegneonategshouldgbegassessedgforg(correctganswe
rs)Erb'sgpalsy.
Preeclampsiagmaygresultgingallgofgthegfollowinggfetalgconditionsg(correctganswers)growthgrestriction,ghy
poxia/neurologicalginjury,gprematurity.
Hyperthermiagisgdefinedgasgangaxillarygtemperatureggreatergthang99.5ºFg(37.5ºC).gThegMOSTgcommong
causegofghyperthermiagingthegnewborngisg(correctganswers)environmental.
Ingthegimmediategnewborngtransitiongperiod,gthegabilitygtogmaintaingfunctionalgresidualglunggcapacitygis
gmostgdependentgupong(correctganswers)angadequategamountgofgalveolargsurfactant.
,Neonatesgatgriskgofghypoglycemiagshouldghavegtheirgglucoseglevelsgevaluatedgwithing2ghoursgofglifegbec
auseg(correctganswers)bloodgglucoseglevelsgreachgtheirglowestgpointgwithingonegtogtwoghoursgaftergdeliv
ery.
Polycythemiagingthegimmediategnewborngperiodgisgoftengassociatedgwithg(correctganswers)infantgofgagd
iabeticgmother.
Symptomsgofgmildgperinatalgasphyxiagincludeg(correctganswers)hyperalertgstategandgjitteriness.
Thegconditiongingwhichgthegnewborn'sgimmatureghypothalamusgdoesgnotgregulategperipheralgbloodgv
essels,gresultinggingagvasoconstrictiongongonegsidegofgthegbodygwithgagvasodilationgongthegoppositegsid
egofgthegbodygisgcalledg(correctganswers)harlequingphenomena.
Thegfollowinggconditionsgmaygallgleadgtogmetabolicgacidosisg(correctganswers)lossgofgHCO3/excessgac
idgloadgd/tgprematurity,grenalgtubulargnecrosis,gseveregdiarrhea,ghypoxia,ghypoperfusion,ginborngerro
rsgofgmetabolism,gcaloricgdeprivation,gintolerancegofgcow'sgmilkgprotein.
Thegfullgnewborngcardiovasculargassessmentgincludesgauscultation,ginspection,gandgpalpation.gThegpoin
tgofgmaximumgimpulsegisgusuallygpalpablegandgcangbegauscultatedgingtheg(correctganswers)thirdgtogfou
rthgintercostalgspacegandgleftgofgthegmidclaviculargline.
Thegneonategborngtogagmothergwithguncontrolledgdiabetesgmellitusgshouldgbegevaluatedgforg(correctgan
swers)congenitalgmalformations.
, Yougaregthegnursegcaringgforgag38gweeksggestation,gfemaleginfant,gwhogwasgborngoneghourgagogingtheg
parkingglotgofgthegemergencygroom.gOngadmissiongtogthegnursery,gthegneonate'sgrectalgtemperaturegw
asg95ºFg(35ºC).gYougrecognizegthatgcoldgstressgmaygpredisposegtheginfantgtog(correctganswers)increase
dgoxygengconsumptiongandghypoxia.
Agfullgtermgneonategwhogpresentsgatgsixghoursgofgagegwithgincreasinglyglabilegoxygenationgthatgappears
gdisproportionategtogthegpulmonarygdiseasegshouldgbegevaluatedgforg(correctganswers)pulmonaryghype
rtensiongofgthegnewborn.
Thegdevelopmentgofgpneumoniagingchronicallygventilatedginfantsgisgmostgcommonlygassociatedgwithgw
hichgofgthegfollowinggorganisms?g(correctganswers)Ureaplasmagurealyticum
Antenatalgsteroidsgenhanceglunggmaturationgbyg(correctganswers)increasinggthegnumbergofgtypegIIgpneu
mocytesgingtheglung.
Meangairwaygpressuregisgdefinedgasgtheg(correctganswers)pressuregtransmittedgtogtheglunggthroughou
tgthegrespiratorygcycle.
Manyginfantsgwithgthegdiagnosisgofgpersistentgpulmonaryghypertensiong(PPHN)gwillghavegpharmacologi
cgsupport.gIdentifygthegmedicationgthatgisgagdirect-
actinggvasodilatorgandgactsgbygrelaxinggpulmonarygvesselgmusculature.g(correctganswers)Nitricgoxide
g g g g
AM(LATEST ANNUAL AACN PRACTICE EXAM 20
g g g g g
22/2023)
Definegthegtermgdeformation
(correctganswers)abnormalitygcausedgbygunusualgmechanicalgforcesgongnormalgtissue.
Aglowgbirthgweightginfant'sgtemperaturegincreasesgduringgskin-to-
skingcare.gThisgisgangexamplegofgheatgtransfergby
(correctganswers)conduction.
Atgthegonsetgofglaborgthegreleasegofgcatecholaminesgstimulatesg(corr
ectganswers)increasedgabsorptiongofglunggfluid.
Angedematous,gbruisedglesiongongthegrightganteriorgscalpgwheregthegvacuumgwasgapplied.gThisglesiong
hasgclearlygdemarcatedgedges,gisgfirmgtogtouch,gandgdoesgnotgcrossgthegsuturegline.gThisgisgbestgdescrib
edgasgag(correctganswers)cephalohematoma.
Anginfantgborngatg40g5/7gweeksggestationgandgweighedg5glbsg2ozg(2,360ggrams).gIngcompletinggaggestat
ionalgagegassessmentgongthisginfant,gyougwouldgidentifyghergasg(correctganswers)term,gsmallgforggestati
onalgage.
,Duringgfetalglife,gthegductusgarteriosusg(correctganswers)divertsgbloodgflowgfromgthegpulmonarygarterygt
ogthegdescendinggaorta.
Expectedgfindingsgingagneonategborngtogagmothergwhogreceivedgmagnesiumgsulfateginglaborgincludeg(co
rrectganswers)hypotonia.
Eyegprophylaxisgwithgagsingle-
usegdosegofgsterilegophthalmicgointmentgcontainingg1%gtetracyclinegorg0.5%gerythromycingisgusuallygad
ministeredgwithingthegfirstgfewghoursgofgbirthgtogpreventgangeyeginfectiongcausedgbyg(correctganswers)
gonorrhea.
Followinggagbirthgcomplicatedgbygshouldergdystocia,gthegneonategshouldgbegassessedgforg(correctganswe
rs)Erb'sgpalsy.
Preeclampsiagmaygresultgingallgofgthegfollowinggfetalgconditionsg(correctganswers)growthgrestriction,ghy
poxia/neurologicalginjury,gprematurity.
Hyperthermiagisgdefinedgasgangaxillarygtemperatureggreatergthang99.5ºFg(37.5ºC).gThegMOSTgcommong
causegofghyperthermiagingthegnewborngisg(correctganswers)environmental.
Ingthegimmediategnewborngtransitiongperiod,gthegabilitygtogmaintaingfunctionalgresidualglunggcapacitygis
gmostgdependentgupong(correctganswers)angadequategamountgofgalveolargsurfactant.
,Neonatesgatgriskgofghypoglycemiagshouldghavegtheirgglucoseglevelsgevaluatedgwithing2ghoursgofglifegbec
auseg(correctganswers)bloodgglucoseglevelsgreachgtheirglowestgpointgwithingonegtogtwoghoursgaftergdeliv
ery.
Polycythemiagingthegimmediategnewborngperiodgisgoftengassociatedgwithg(correctganswers)infantgofgagd
iabeticgmother.
Symptomsgofgmildgperinatalgasphyxiagincludeg(correctganswers)hyperalertgstategandgjitteriness.
Thegconditiongingwhichgthegnewborn'sgimmatureghypothalamusgdoesgnotgregulategperipheralgbloodgv
essels,gresultinggingagvasoconstrictiongongonegsidegofgthegbodygwithgagvasodilationgongthegoppositegsid
egofgthegbodygisgcalledg(correctganswers)harlequingphenomena.
Thegfollowinggconditionsgmaygallgleadgtogmetabolicgacidosisg(correctganswers)lossgofgHCO3/excessgac
idgloadgd/tgprematurity,grenalgtubulargnecrosis,gseveregdiarrhea,ghypoxia,ghypoperfusion,ginborngerro
rsgofgmetabolism,gcaloricgdeprivation,gintolerancegofgcow'sgmilkgprotein.
Thegfullgnewborngcardiovasculargassessmentgincludesgauscultation,ginspection,gandgpalpation.gThegpoin
tgofgmaximumgimpulsegisgusuallygpalpablegandgcangbegauscultatedgingtheg(correctganswers)thirdgtogfou
rthgintercostalgspacegandgleftgofgthegmidclaviculargline.
Thegneonategborngtogagmothergwithguncontrolledgdiabetesgmellitusgshouldgbegevaluatedgforg(correctgan
swers)congenitalgmalformations.
, Yougaregthegnursegcaringgforgag38gweeksggestation,gfemaleginfant,gwhogwasgborngoneghourgagogingtheg
parkingglotgofgthegemergencygroom.gOngadmissiongtogthegnursery,gthegneonate'sgrectalgtemperaturegw
asg95ºFg(35ºC).gYougrecognizegthatgcoldgstressgmaygpredisposegtheginfantgtog(correctganswers)increase
dgoxygengconsumptiongandghypoxia.
Agfullgtermgneonategwhogpresentsgatgsixghoursgofgagegwithgincreasinglyglabilegoxygenationgthatgappears
gdisproportionategtogthegpulmonarygdiseasegshouldgbegevaluatedgforg(correctganswers)pulmonaryghype
rtensiongofgthegnewborn.
Thegdevelopmentgofgpneumoniagingchronicallygventilatedginfantsgisgmostgcommonlygassociatedgwithgw
hichgofgthegfollowinggorganisms?g(correctganswers)Ureaplasmagurealyticum
Antenatalgsteroidsgenhanceglunggmaturationgbyg(correctganswers)increasinggthegnumbergofgtypegIIgpneu
mocytesgingtheglung.
Meangairwaygpressuregisgdefinedgasgtheg(correctganswers)pressuregtransmittedgtogtheglunggthroughou
tgthegrespiratorygcycle.
Manyginfantsgwithgthegdiagnosisgofgpersistentgpulmonaryghypertensiong(PPHN)gwillghavegpharmacologi
cgsupport.gIdentifygthegmedicationgthatgisgagdirect-
actinggvasodilatorgandgactsgbygrelaxinggpulmonarygvesselgmusculature.g(correctganswers)Nitricgoxide
